Provider Demographics
NPI:1639510613
Name:SAMONA, JASON (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SAMONA
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1282
Mailing Address - Country:US
Mailing Address - Phone:248-845-4705
Mailing Address - Fax:269-727-0462
Practice Address - Street 1:6905 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1282
Practice Address - Country:US
Practice Address - Phone:248-845-4705
Practice Address - Fax:269-727-0462
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020790207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101020790OtherMI LICENSE