Healthcare Provider Details

I. General information

NPI: 1841362506
Provider Name (Legal Business Name): AMI K MAVANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 W AVON RD STE 10
ROCHESTER HILLS MI
48307-2760
US

IV. Provider business mailing address

940 W AVON RD STE 10
ROCHESTER HILLS MI
48307-2760
US

V. Phone/Fax

Practice location:
  • Phone: 248-650-5009
  • Fax: 248-652-9557
Mailing address:
  • Phone: 248-650-5009
  • Fax: 248-652-9557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301066555
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: