Provider Demographics
NPI:1871570341
Name:AMUKELE, SAMUEL A (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:A
Last Name:AMUKELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 PALM AVE
Mailing Address - Street 2:UROLOGY DEPARTMENT
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-8404
Mailing Address - Country:US
Mailing Address - Phone:619-662-5458
Mailing Address - Fax:619-662-5470
Practice Address - Street 1:4650 PALM AVE
Practice Address - Street 2:UROLOGY DEPARTMENT
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-8404
Practice Address - Country:US
Practice Address - Phone:619-662-5458
Practice Address - Fax:619-662-5470
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97898208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02662779Medicaid
39R811Medicare ID - Type Unspecified
NY02662779Medicaid