Individual
TERRI T SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, ROOM 1204A, INDIANAPOLIS, IN 46202-1239
(317) 962-6793
(317) 962-8281
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01061730
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000489622
ANTHEM BCBS
IN
05
—
200832500
—
IN
01
—
P00366169
RAILROAD MEDICARE
IN
01
—
P00742679
RAILROAD MEDICARE
IN
Enumeration date
06/14/2006
Last updated
02/16/2021
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