MEDICARE: MICHAEL A SAMUEL M.D.

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	207W00000X	Ophthalmology Physician	A83237	CA
2	207W00000X	Ophthalmology Physician	35090825	OH
3	207WX0107X	Retina Specialist (Ophthalmology) Physician	A83237	CA

General Provider Information

NPI Number	:	1730175670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A SAMUEL M.D.

Provider Business Mailing Address
First Line	:	800 FAIRMOUNT AVE
Second Line	:	SUITE 312
City	:	PASADENA
State	:	CA
Zip	:	91105-3150
Country	:	US
Telephone Number	:	626-568-8838
Fax Number	:	626-583-8838

Provider Business Practice Location Address
First Line	:	44139 MONTEREY AVE STE A
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-8700
Country	:	US
Telephone Number	:	760-779-0800
Fax Number	:	760-779-0801

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	04/05/2021

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Directions to “ MICHAEL A SAMUEL M.D.” Practice Location

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