Individual
SANJU SUSAN SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6701 FANNIN ST, HOUSTON, TX 77030-2608
(832) 824-1000
Mailing address
2 GREENWAY PLZ STE 300, HOUSTON, TX 77046-0207
(832) 828-3660
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
N1124
TX
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
N1124
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
281902101
—
TX
01
—
8CV528
BCBS
TX
Enumeration date
04/18/2007
Last updated
02/14/2025
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