Provider Demographics
NPI:1326056003
Name:MUCHA, SAMANTHA M (MD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:M
Last Name:MUCHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 SEAGATE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:567-585-1918
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:777 KIMOLE LN
Practice Address - Street 2:SUITE 240
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1478
Practice Address - Country:US
Practice Address - Phone:517-263-9491
Practice Address - Fax:517-263-9591
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301088792207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI000000493280OtherANTHEM
MI0404610882OtherBCBS MI
06316OtherPARAMOUNT
MI156940OtherGLHP
MI4928260Medicaid
MIP00357849OtherRRMC
MI144133OtherCARE CHOICE PREFERRED C
7819885OtherAETNA
40042OtherHPM
MI4907804Medicaid
$$$$$$$$$OtherHEALTH NET FEDERAL
7819885OtherAETNA
MIP00357849OtherRRMC