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General NPI Number Information
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NPI Number | 1235165093
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Entity Type | Individual
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Provider Name | SAMRAJA EMERSON MD
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Gender | Male
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1234 NAPIER AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2112
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Country | US
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Telephone | 269-471-1700
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Fax | 269-471-1975
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Provider Business Mailing Address
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Address Line | PO BOX 458
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City | NILES
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State | MI
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Zip | 49120-0458
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Country | US
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Telephone | 269-687-1136
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Fax | 269-684-0189
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301080738
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License Number State | MI
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