Healthcare Provider Details

I. General information

NPI: 1619474459
Provider Name (Legal Business Name): AMANDA JANE PARIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37595 7 MILE RD STE 230
LIVONIA MI
48152-1003
US

IV. Provider business mailing address

37595 7 MILE RD STE 230
LIVONIA MI
48152-1003
US

V. Phone/Fax

Practice location:
  • Phone: 734-853-5694
  • Fax: 734-430-9388
Mailing address:
  • Phone: 734-853-5694
  • Fax: 734-430-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301505599
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: