MEDICARE: AMY PATEL COUTURIER 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	208000000X	Pediatrics Physician	149706	CA
2	208000000X	Pediatrics Physician	4301503517	MI

General Provider Information

NPI Number	:	1902224215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY PATEL COUTURIER MD

Provider Business Mailing Address
First Line	:	802 S GARFIELD AVE STE C
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-3487
Country	:	US
Telephone Number	:	231-714-4193
Fax Number	:	952-333-7883

Provider Business Practice Location Address
First Line	:	802 S GARFIELD AVE STE C
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-3487
Country	:	US
Telephone Number	:	231-714-4193
Fax Number	:	952-333-7883

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

Provider Enumeration Date	:	04/03/2014
Last Update Date	:	07/02/2021

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