MEDICARE: AMOD S TOOTLA MD

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	208600000X	Surgery Physician	AT031237	MI
2	208C00000X	Colon & Rectal Surgery Physician	4301031237	MI
3	174400000X	Specialist	4301031237	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841340510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMOD S TOOTLA MD

Provider Business Mailing Address
First Line	:	5220 HIGHLAND RD STE 200
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-1973
Country	:	US
Telephone Number	:	248-334-3197
Fax Number	:	248-335-8857

Provider Business Practice Location Address
First Line	:	5220 HIGHLAND RD STE 200
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-1973
Country	:	US
Telephone Number	:	248-334-3197
Fax Number	:	248-335-8857

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	01/31/2022

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Directions to “ AMOD S TOOTLA MD” Practice Location

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