Provider Demographics
NPI:1669051207
Name:VOKAL, SAMUEL GEORGE
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:GEORGE
Last Name:VOKAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 MACKINAW RD STE 2300
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-8211
Mailing Address - Country:US
Mailing Address - Phone:989-753-4000
Mailing Address - Fax:
Practice Address - Street 1:5400 MACKINAW RD STE 2300
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-8211
Practice Address - Country:US
Practice Address - Phone:989-753-4000
Practice Address - Fax:989-754-4000
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2024-11-19
Deactivation Date:2024-04-23
Deactivation Code:
Reactivation Date:2024-05-10
Provider Licenses
StateLicense IDTaxonomies
MI5601012829363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program