Provider Demographics
NPI:1063417053
Name:SAMUEL, STEVEN FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:FREDERICK
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 QUARTERMASTER CT
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3627
Mailing Address - Country:US
Mailing Address - Phone:502-583-7741
Mailing Address - Fax:502-290-9743
Practice Address - Street 1:141 QUARTERMASTER CT
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3627
Practice Address - Country:US
Practice Address - Phone:502-583-7741
Practice Address - Fax:502-290-9743
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22794208600000X
IN01044785A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100366810Medicaid
KY64227945Medicaid
KY64227945Medicaid
KYC70791Medicare UPIN
IN100366810AMedicaid