Healthcare Provider Details

I. General information

NPI: 1033406368
Provider Name (Legal Business Name): NOSHIR YAZDI AMARIA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FLETCHER ST
ANN ARBOR MI
48109-1050
US

IV. Provider business mailing address

207 FLETCHER ST
ANN ARBOR MI
48109-1050
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-8320
  • Fax:
Mailing address:
  • Phone: 734-764-8320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number5101019321
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number5101019321
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: