Organization
SAMUELSON ENTERPRISES, PLLC
Active
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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