# DR. SAMUEL PENNELLA JR.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1124524038
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 4301510893 | MI | Yes |
| 208D00000X | General Practice Physician | 68449 | MN | — |
| 208D00000X | General Practice Physician | DR.0074417 | CO | — |
| 208D00000X | General Practice Physician | TPME2986 | FL | — |
| 208D00000X | General Practice Physician | TW00059 | KS | — |

## Other

- **Enumeration date:** 04/02/2018
- **Last updated:** 05/06/2026