S Samuel Im MD PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

4301031469 Issued in MI

Legal business name

S SAMUEL IM MD PC

Practice address

485 E Columbia Ave
Suite 11 a
Battle Creek, MI 49014-5499

Phone

(269) 969-6211

Fax

(269) 969-6049

NPI assigned

Feb 10, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Sunggeun Samuel Im, M.D.

Title

Owner

Phone

(269) 969-6211

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265760000000",
    "number": "1528390952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "485 E COLUMBIA AVE",
            "address_2": "SUITE 11 A",
            "city": "BATTLE CREEK",
            "state": "MI",
            "postal_code": "490145499",
            "telephone_number": "269-969-6211",
            "fax_number": "269-969-6049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "485 E COLUMBIA AVE",
            "address_2": "SUITE 11 A",
            "city": "BATTLE CREEK",
            "state": "MI",
            "postal_code": "490145499",
            "telephone_number": "269-969-6211",
            "fax_number": "269-969-6049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S SAMUEL IM MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-10",
        "last_updated": "2010-02-10",
        "status": "A",
        "authorized_official_last_name": "IM",
        "authorized_official_first_name": "SUNGGEUN",
        "authorized_official_middle_name": "SAMUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-969-6211",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "4301031469",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1077038",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Battle Creek, MI
• Providers in Battle Creek, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.