Provider Demographics
NPI:1295114387
Name:KIEFER, SAMANTHA NICHOLE (DO)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NICHOLE
Last Name:KIEFER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 W MAIN RD STE F
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2057
Mailing Address - Country:US
Mailing Address - Phone:440-599-7466
Mailing Address - Fax:440-593-6498
Practice Address - Street 1:167 W MAIN RD STE F
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2057
Practice Address - Country:US
Practice Address - Phone:440-599-7466
Practice Address - Fax:440-593-6498
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34.013424OtherOH MEDICAL LICENSE
OHFK7626180OtherDEA