MEDICARE: AMANDA RAE ANTCZAK PA-C

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	363A00000X	Physician Assistant	5601007539	MI

General Provider Information

NPI Number	:	1750752481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA RAE ANTCZAK PA-C

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD STE 3D
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	44201 DEQUINDRE RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-1117
Country	:	US
Telephone Number	:	248-964-5000
Fax Number	:

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

Provider Enumeration Date	:	10/07/2015
Last Update Date	:	06/01/2026

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