Individual
DR. MATTHEW I SAMUELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
420 N IL ROUTE 31, CRYSTAL LAKE, IL 60012-3711
(815) 356-5200
(815) 356-5262
Mailing address
420 N IL ROUTE 31, CRYSTAL LAKE, IL 60012-3711
(815) 356-5200
(815) 356-5262
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
036086139
IL
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
Primary
036-086139
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036086139
—
IL
Enumeration date
11/15/2006
Last updated
08/08/2017
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