MEDICARE: NALINI SAMUEL MD PC

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	2084N0400X	Neurology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0G41016	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1336238831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NALINI SAMUEL MD PC

Provider Business Mailing Address
First Line	:	3050 KRAFFT RD
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-3821
Country	:	US
Telephone Number	:	810-385-7700
Fax Number	:	810-385-7760

Provider Business Practice Location Address
First Line	:	3050 KRAFFT RD
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-3821
Country	:	US
Telephone Number	:	810-385-7700
Fax Number	:	810-385-7760

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	MS. NALINI SAMUEL
Credential	:	MD
Telephone Number	:	810-385-7700

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/22/2020

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