Healthcare Provider Details

I. General information

NPI: 1326056003
Provider Name (Legal Business Name): SAMANTHA M MUCHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 KIMOLE LN SUITE 240
ADRIAN MI
49221-1478
US

IV. Provider business mailing address

1 SEAGATE SUITE 800
TOLEDO OH
43604-1558
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-9491
  • Fax: 517-263-9591
Mailing address:
  • Phone: 567-585-1918
  • Fax: 419-824-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301088792
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: