Provider Demographics
NPI:1093462202
Name:MERCHUN, SAMUEL ALEXANDER (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ALEXANDER
Last Name:MERCHUN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7160 CUESTA WAY DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9493
Mailing Address - Country:US
Mailing Address - Phone:616-826-9787
Mailing Address - Fax:
Practice Address - Street 1:4100 EMBASSY DR SE STE 400
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2416
Practice Address - Country:US
Practice Address - Phone:616-988-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical