Provider Demographics
NPI:1710116454
Name:SAM, MICHELINE (ARNP)
Entity type:Individual
Prefix:
First Name:MICHELINE
Middle Name:
Last Name:SAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 N MICHIGAN AVE STE 1998
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-7504
Mailing Address - Country:US
Mailing Address - Phone:855-386-2799
Mailing Address - Fax:
Practice Address - Street 1:1825 NW 167TH ST STE 108
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4838
Practice Address - Country:US
Practice Address - Phone:305-474-1803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9192688363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner