Healthcare Provider Details

I. General information

NPI: 1720481476
Provider Name (Legal Business Name): SAMANTHA REIDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

IHA HOSPITAL MEDICINE SERVICES 5301 MCAULEY DRIVE
YPSILANTI MI
48197
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DRIVE J2000
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-8676
  • Fax:
Mailing address:
  • Phone: 734-747-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007128
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601007128
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: