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NPI Code Detail

MEDICARE: SAMANTHA BROOMHEAD PA

MEDICARE: SAMANTHA BROOMHEAD PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant5601003366MI

General Provider Information

NPI Number : 1598733180
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA BROOMHEAD PA
Provider Business Mailing Address
First Line : 11061 BEDFORD DR
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48313-4001
Country : US
Telephone Number : 586-484-8458
Fax Number :
Provider Business Practice Location Address
First Line : 2799 W GRAND BLVD
Second Line :
City : DETROIT
State : MI
Zip : 48202-2689
Country : US
Telephone Number : 313-916-2600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 05/19/2022

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Directions to “ SAMANTHA BROOMHEAD PA” Practice Location

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