Provider Demographics
NPI:1003880907
Name:STORCH, SAMUEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:J
Last Name:STORCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 UNIVERSITY AVE STE 321
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8289
Mailing Address - Country:US
Mailing Address - Phone:515-875-9255
Mailing Address - Fax:515-875-9101
Practice Address - Street 1:5950 UNIVERSITY AVE STE 341
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8289
Practice Address - Country:US
Practice Address - Phone:515-875-9255
Practice Address - Fax:515-875-9101
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-46783208800000X
NC30099174400000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1003880907OtherRAILROAD MEDICARE
VA1003880907Medicaid
NC80179OtherBLUECROSS BLUESHIELD
NC7980179Medicaid
NC1003880907OtherBLUE MEDICARE
NC1003880907OtherBLUE MEDICARE
NC80179OtherBLUECROSS BLUESHIELD
VA1003880907Medicaid