Healthcare Provider Details

I. General information

NPI: 1376706036
Provider Name (Legal Business Name): AMY BETH ENGELHARDT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W. GRAND BLVD.
DETROIT MI
48202
US

IV. Provider business mailing address

HENRY FORD HOSPITAL 2799 W. GRAND BLVD CFP-417
DETROIT MI
48202
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-8144
  • Fax:
Mailing address:
  • Phone: 313-916-8144
  • Fax: 313-916-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101016440
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number5101016440
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: