MEDICARE: SAMANTHA REIDT PA-C

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
1	363A00000X	Physician Assistant	5601007128	MI
2	363AM0700X	Medical Physician Assistant	5601007128	MI

General Provider Information

NPI Number	:	1720481476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA REIDT PA-C

Provider Business Mailing Address
First Line	:	24 FRANK LLOYD WRIGHT DRIVE
Second Line	:	J2000
City	:	ANN ARBOR
State	:	MI
Zip	:	48105
Country	:	US
Telephone Number	:	734-747-6766
Fax Number	:

Provider Business Practice Location Address
First Line	:	IHA HOSPITAL MEDICINE SERVICES
Second Line	:	5301 MCAULEY DRIVE
City	:	YPSILANTI
State	:	MI
Zip	:	48197
Country	:	US
Telephone Number	:	734-712-8676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2014
Last Update Date	:	03/16/2026

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