Healthcare Provider Details

I. General information

NPI: 1275425852
Provider Name (Legal Business Name): AMEL M MRYYIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

3140 E MICHIGAN AVE APT 515
LANSING MI
48912-4674
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-2157
  • Fax:
Mailing address:
  • Phone: 517-303-9701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351054398
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: