MEDICARE: SAMANTHA BETH KING AU.D.

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
1	231H00000X	Audiologist	1601000471	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	640A312270	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1679752042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA BETH KING AU.D.

Provider Business Mailing Address
First Line	:	601 JOHN ST # 42
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-5341
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4855 W CENTRE AVE
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-4686
Country	:	US
Telephone Number	:	269-372-2709
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	12/30/2022

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