Provider Demographics
NPI:1871525592
Name:MENDOZA, SAMUEL ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ALLEN
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2215 FULLER RD RM A793
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2303
Mailing Address - Country:US
Mailing Address - Phone:734-845-3471
Mailing Address - Fax:
Practice Address - Street 1:2215 FULLER RD RM A793
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2303
Practice Address - Country:US
Practice Address - Phone:734-845-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010847832084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry