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NPI Code Detail

MEDICARE: SAMANTHA ANNA WLOCH PHYSICIAN ASSISTANT

MEDICARE: SAMANTHA ANNA WLOCH PHYSICIAN ASSISTANT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant9111230FL
2363A00000XPhysician Assistant15621MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275022618
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA ANNA WLOCH PHYSICIAN ASSISTANT
Provider Business Mailing Address
First Line : 7595 ANAGRAM DR
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-7399
Country : US
Telephone Number : 612-573-2200
Fax Number : 612-573-2274
Provider Business Practice Location Address
First Line : 7595 ANAGRAM DR
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-7399
Country : US
Telephone Number : 612-573-2200
Fax Number : 612-573-2274
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2018
Last Update Date : 12/09/2025

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