MEDICARE: MICHAEL S SAMUELS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	23070	FL

General Provider Information

NPI Number	:	1669122867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL S SAMUELS DO

Provider Business Mailing Address
First Line	:	1524 PINTO LN FL 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4195
Country	:	US
Telephone Number	:	702-780-7588
Fax Number	:	702-754-6505

Provider Business Practice Location Address
First Line	:	4651 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3457
Country	:	US
Telephone Number	:	954-989-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	04/08/2026

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