MEDICARE: DR. AMY KODRIK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	015030	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457321184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY KODRIK D.O.

Provider Business Mailing Address
First Line	:	28595 ORCHARD LAKE RD
Second Line	:	SUITE 200
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2977
Country	:	US
Telephone Number	:	248-553-0010
Fax Number	:	248-553-5957

Provider Business Practice Location Address
First Line	:	25150 FORD RD STE 100
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3163
Country	:	US
Telephone Number	:	248-553-0010
Fax Number	:	248-553-5957

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	03/06/2025

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