Individual
MARY ELLYN SAMELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5230 E STOP 11 RD STE 150, INDIANAPOLIS, IN 46237-6399
(317) 865-5904
(317) 865-5321
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004528A
IN
Other
Enumeration date
09/30/2024
Last updated
09/30/2024
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