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NPI Code Detail

MEDICARE: JUSITH A AMPARO DO

MEDICARE: JUSITH A AMPARO DO
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
1208600000XSurgery Physician5101011802MI

Other Identifiers

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

General Provider Information

NPI Number : 1790869329
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSITH A AMPARO DO
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE MC 845
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 707 S GREENVILLE WEST DR
Second Line :
City : GREENVILLE
State : MI
Zip : 48838-2102
Country : US
Telephone Number : 616-754-3001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 02/24/2021

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