Individual
VIJAYA P SAMUEL
Active
Individual
VIJAYA P SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
04-29522
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-29522
MEDICAL LICENSE
KS
05
—
100425510C
—
KS
05
—
1104810803
—
MO
Enumeration date
09/08/2005
Last updated
10/05/2009
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