Healthcare Provider Details

I. General information

NPI: 1144478470
Provider Name (Legal Business Name): AMI ANNA HATTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HURLEY PLZ
FLINT MI
48503-5902
US

IV. Provider business mailing address

1 HURLEY PLZ
FLINT MI
48503-5902
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-9841
  • Fax:
Mailing address:
  • Phone: 810-257-9841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301079539
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: