Individual
MR. PREM KUMAR SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5701 W 119TH ST, SUITE 120, OVERLAND PARK, KS 66209-3721
(913) 906-0833
(816) 523-5747
Mailing address
5701 W 119TH ST, SUITE 120, OVERLAND PARK, KS 66209-3721
(913) 906-0833
(816) 523-5747
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
29521
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100416510B
—
KS
05
—
100416510C
—
KS
05
—
205761604
—
MO
Enumeration date
05/26/2006
Last updated
01/21/2014
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