Individual
JACOB N-B SAMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1111 RONALD REAGAN PKWY, AVON, IN 46123-7085
(317) 217-3649
(317) 217-3474
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01088072A
IN
207R00000X
Internal Medicine Physician
D87885
MD
208M00000X
Hospitalist Physician
D87885
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068010929
MEDICARE PTAN
IN
05
—
300069401
—
IN
Enumeration date
02/10/2014
Last updated
12/29/2023
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