Provider Demographics
NPI:1477938470
Name:ENGELS, SAMANTHA JOLENE OCTAVIA (MD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JOLENE OCTAVIA
Last Name:ENGELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 GLENVIEW RD, UNIT 3
Mailing Address - Street 2:
Mailing Address - City:PETROLIA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N0N 1R0
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4130 GLENVIEW RD, UNIT 3
Practice Address - Street 2:
Practice Address - City:PETROLIA
Practice Address - State:ONTARIO
Practice Address - Zip Code:N0N 1R0
Practice Address - Country:CA
Practice Address - Phone:519-882-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301108323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine