Healthcare Provider Details

I. General information

NPI: 1063577625
Provider Name (Legal Business Name): SVETLANA O AMINOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SOUTH BLVD E SUITE 160
ROCHESTER HLS MI
48307-6122
US

IV. Provider business mailing address

PO BOX 71011
ROCHESTER HLS MI
48307-0019
US

V. Phone/Fax

Practice location:
  • Phone: 248-598-5080
  • Fax: 248-598-5080
Mailing address:
  • Phone: 248-879-2836
  • Fax: 248-551-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number4301080284
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: