Most Relevant Information
Provider Data
| NPI Number: | 1003267303 |
| Provider Name: | SAMANTHA MISHRA DO |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/28/2016 |
| Last Updated: | 06/28/2016 |
Provider Practice Location
205 N EAST AVE
JACKSON
MI
492011753
Practice Location Phone/Fax
| Phone: | 5177884800 |
| Fax: | 5178177050 |
Provider Mailing Location
205 N EAST AVE
JACKSON
MI
492011753
Provider Mailing Phone/Fax
| Phone: | 5177884800 |
| Fax: | 5178177050 |