Provider Demographics
NPI:1659012177
Name:SAMANT, SONIA AJAY (MD)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:AJAY
Last Name:SAMANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 MICHIGAN ST NE STE A601
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-391-3245
Mailing Address - Fax:616-391-3130
Practice Address - Street 1:100 MICHIGAN ST NE STE A601
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-391-3245
Practice Address - Fax:616-391-3130
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2023-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43510496242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology