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General NPI Number Information
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NPI Number | 1427397462
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Entity Type | Individual
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Provider Name | SAMUEL JACOB MICHEL MD
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Gender | Male
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Dates
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Enumeration Date | 02/12/2013
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 84 MARGINAL WAY STE 900
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City | PORTLAND
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State | ME
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Zip | 04101-2476
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Country | US
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Telephone | 207-347-2683
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Fax |
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Provider Business Mailing Address
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Address Line | 300 SOUTHBOROUGH DR STE 120
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-6978
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Country | US
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Telephone | 207-347-2947
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 61021035
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License Number State | WA
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