Healthcare Provider Details

I. General information

NPI: 1639790025
Provider Name (Legal Business Name): SAMANTHA ARSENAULT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202-2689
US

IV. Provider business mailing address

7230 ORCHARD LAKE RD
WEST BLOOMFIELD MI
48322-3603
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2020
  • Fax: 313-916-1327
Mailing address:
  • Phone: 248-847-4980
  • Fax: 248-847-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301514210
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME166906
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: