Individual
DR. GRACE KOLLANNOOR SAMUEL
Active
Individual
DR. GRACE KOLLANNOOR SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MBBS, MS, PHD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
78971
MN
207R00000X
Internal Medicine Physician
8472620
WI
208D00000X
General Practice Physician
8472620
WI
Other
Enumeration date
04/15/2022
Last updated
09/17/2025
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