Healthcare Provider Details

I. General information

NPI: 1598226532
Provider Name (Legal Business Name): SAMANTHA WIRKOWSKI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2019
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1873
US

IV. Provider business mailing address

1 CHILDRENS PLZ
DAYTON OH
45404-1873
US

V. Phone/Fax

Practice location:
  • Phone: 952-913-1343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number34.017912
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: