Organization
SAMUELSON ENTERPRISES, PLLC
Active
Other names
Grace Wellness Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
PROF. BENSSON VARGHESE SAMUEL MD, PHD, DBA, ED.D (DIRECTOR/OWNER)
(248) 792-9864
Entity
Organization
Contact information
Practice address
3930 MOUNT VERNON DR, BLOOMFIELD HILLS, MI 48301-3226
(202) 262-2218
Mailing address
545 ASHMUN ST UNIT 5, SAULT SAINTE MARIE, MI 49783-1936
(202) 262-2218
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RH0005X
Hypertension Specialist Physician
—
—
207RN0300X
Nephrology Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
251E00000X
Home Health Agency
—
—
251G00000X
Community Based Hospice Care Agency
—
MI
261QC1800X
Corporate Health Clinic/Center
—
MI
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
MI
261QI0500X
Infusion Therapy Clinic/Center
—
MI
305S00000X
Point of Service
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
343800000X
Secured Medical Transport (VAN)
—
—
385HR2050X
Respite Care Camp
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710240403
—
PA
Enumeration date
01/12/2018
Last updated
10/29/2024
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