MEDICARE: BEATA E SAMUEL MD

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	208000000X	Pediatrics Physician	01064081A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083656011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATA E SAMUEL MD

Provider Business Mailing Address
First Line	:	51 N FORD RD
Second Line	:
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-1233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 N FORD RD
Second Line	:
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-1233
Country	:	US
Telephone Number	:	317-973-3333
Fax Number	:

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	08/12/2022

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Directions to “ BEATA E SAMUEL MD” Practice Location

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