Healthcare Provider Details

I. General information

NPI: 1174086839
Provider Name (Legal Business Name): MRS. SAMANTHA N SULZER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30600 TELEGRAPH RD STE 4000
BINGHAM FARMS MI
48025-5726
US

IV. Provider business mailing address

4288 FIELDBROOK RD
WEST BLOOMFIELD MI
48323-3210
US

V. Phone/Fax

Practice location:
  • Phone: 248-953-2103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02190899
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: