Healthcare Provider Details

I. General information

NPI: 1497246698
Provider Name (Legal Business Name): AMBER ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29355 NORTHWESTERN HWY STE 302B
SOUTHFIELD MI
48034-1053
US

IV. Provider business mailing address

18100 OAKWOOD BLVD STE 300
DEARBORN MI
48124-4085
US

V. Phone/Fax

Practice location:
  • Phone: 248-228-2477
  • Fax: 248-281-1764
Mailing address:
  • Phone: 313-429-7844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601008670
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: