Healthcare Provider Details

I. General information

NPI: 1023509981
Provider Name (Legal Business Name): SAMUEL JOHN MUENCH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W 13 MILE RD
ROYAL OAK MI
48073-6712
US

IV. Provider business mailing address

114 PINEWOOD DR
PLYMOUTH MI
48170-1868
US

V. Phone/Fax

Practice location:
  • Phone: 248-898-0123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5601008669
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601008669
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: