Healthcare Provider Details

I. General information

NPI: 1073531257
Provider Name (Legal Business Name): SAMUEL HORTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 N MERIDIAN ST # 101
CARMEL IN
46032-1404
US

IV. Provider business mailing address

13000 N MERIDIAN ST STE 101
CARMEL IN
46032-1404
US

V. Phone/Fax

Practice location:
  • Phone: 317-208-3855
  • Fax: 317-208-3847
Mailing address:
  • Phone: 317-208-3855
  • Fax: 317-208-3847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01060857A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: