Healthcare Provider Details

I. General information

NPI: 1811302243
Provider Name (Legal Business Name): AMIMUL CHOUDHURY,MD.PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 N MONROE ST
MONROE MI
48162-3113
US

IV. Provider business mailing address

1052 N MONROE ST
MONROE MI
48162-3113
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-9550
  • Fax: 734-242-2313
Mailing address:
  • Phone: 734-242-9550
  • Fax: 734-242-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301052445
License Number StateMI

VIII. Authorized Official

Name: AMIMUL CHOUDHURY
Title or Position: PHYSICIAN
Credential: MD
Phone: 734-242-9550