Healthcare Provider Details

I. General information

NPI: 1316175433
Provider Name (Legal Business Name): SHOSHANA WOO AMBANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHOSHANA LARA WOO M.D.

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 08/09/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 S HURON PKWY
ANN ARBOR MI
48104-5151
US

IV. Provider business mailing address

455 EAST EISENHOWER PARKWAY SUITE 300, PMB1021
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 734-274-9550
  • Fax: 734-407-8004
Mailing address:
  • Phone: 734-274-9550
  • Fax: 734-407-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number4301094278
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD458694
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35.154675
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: