Individual
MICAH Y SAMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
301 WEBB ST, CALUMET CITY, IL 60409-4715
(312) 204-9591
Mailing address
301 WEBB ST, CALUMET CITY, IL 60409-4715
(312) 204-9591
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
IL
Other
Enumeration date
10/12/2022
Last updated
10/12/2022
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