Healthcare Provider Details

I. General information

NPI: 1770362055
Provider Name (Legal Business Name): AMI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W WASHINGTON AVE STE 102
JACKSON MI
49201-2141
US

IV. Provider business mailing address

1344 NAPA
CANTON MI
48187-7721
US

V. Phone/Fax

Practice location:
  • Phone: 517-435-0260
  • Fax:
Mailing address:
  • Phone: 734-560-7806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704349483
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: