Provider Demographics
NPI:1932266434
Name:PETER M SAMET MD PLC
Entity type:Organization
Organization Name:PETER M SAMET MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAMET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-644-8454
Mailing Address - Street 1:PO BOX 251478
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-1478
Mailing Address - Country:US
Mailing Address - Phone:248-809-6200
Mailing Address - Fax:248-809-6105
Practice Address - Street 1:15600 W 12 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3068
Practice Address - Country:US
Practice Address - Phone:248-809-6200
Practice Address - Fax:248-809-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P34600Medicare PIN