Provider Demographics
NPI:1023284403
Name:SAMSON, JUDITH ANNE (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:SAMSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 LEXINGTON LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1026
Mailing Address - Country:US
Mailing Address - Phone:312-498-4482
Mailing Address - Fax:847-433-2381
Practice Address - Street 1:2808 LEXINGTON LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-1026
Practice Address - Country:US
Practice Address - Phone:312-498-4482
Practice Address - Fax:847-433-2381
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107911207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology