Healthcare Provider Details

I. General information

NPI: 1992299531
Provider Name (Legal Business Name): AMANDA SALLY ALEXANDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W 13 MILE RD STE EC
ROYAL OAK MI
48073-6712
US

IV. Provider business mailing address

3535 W 13 MILE RD
ROYAL OAK MI
48073-6770
US

V. Phone/Fax

Practice location:
  • Phone: 248-898-5058
  • Fax:
Mailing address:
  • Phone: 248-551-3000
  • Fax: 248-551-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number4301504641
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301504641
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: