Healthcare Provider Details

I. General information

NPI: 1669051207
Provider Name (Legal Business Name): SAMUEL GEORGE VOKAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date: 04/23/2024
Reactivation Date: 05/10/2024

III. Provider practice location address

4100 CAMPUS RIDGE DR
MIDLAND MI
48640-6139
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

V. Phone/Fax

Practice location:
  • Phone: 989-839-1795
  • Fax: 989-839-1785
Mailing address:
  • Phone: 844-832-1956
  • Fax: 989-633-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601012829
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: