Healthcare Provider Details

I. General information

NPI: 1417887787
Provider Name (Legal Business Name): AMANDA M MCGANN MD/PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 PLYMOUTH RD BLDG 35-1411
ANN ARBOR MI
48109-2801
US

IV. Provider business mailing address

2800 PLYMOUTH RD BLDG 35-1411
ANN ARBOR MI
48109-2801
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-3270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4351056523
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: