Healthcare Provider Details

I. General information

NPI: 1477992360
Provider Name (Legal Business Name): AMANDA L. WINSTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 DAVISON RD
DAVISON MI
48423-1037
US

IV. Provider business mailing address

9244 LAPEER RD
DAVISON MI
48423-1757
US

V. Phone/Fax

Practice location:
  • Phone: 810-412-5700
  • Fax: 810-412-5755
Mailing address:
  • Phone: 810-653-2111
  • Fax: 810-653-8506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301103706
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301103706
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: