Healthcare Provider Details

I. General information

NPI: 1588976013
Provider Name (Legal Business Name): AMANDA DYAN ZILKA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA DYAN ATTERBERRY PA-C

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15450 NORTHLINE RD STE 101
SOUTHGATE MI
48195-2398
US

IV. Provider business mailing address

1640 FORT ST SUITE D ATTN DENISE
TRENTON MI
48183-2040
US

V. Phone/Fax

Practice location:
  • Phone: 734-282-2020
  • Fax: 734-282-2002
Mailing address:
  • Phone: 734-391-3057
  • Fax: 734-391-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005727
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: