Healthcare Provider Details

I. General information

NPI: 1790193084
Provider Name (Legal Business Name): AMANDA HALLBERG MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 05/29/2025
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 S. STATE STREET SUITE 215
ANN ARBOR MI
48104
US

IV. Provider business mailing address

2880 S. STATE STREET SUITE 215
ANN ARBOR MI
48104
US

V. Phone/Fax

Practice location:
  • Phone: 734-547-3990
  • Fax: 734-547-3980
Mailing address:
  • Phone: 734-547-3990
  • Fax: 734-547-3980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4301081734
License Number StateMI

VIII. Authorized Official

Name: AMANDA JOY HALLBERG
Title or Position: PHYSICIAN OWNER/SOLE OWNER
Credential: MD
Phone: 734-547-3990