Healthcare Provider Details

I. General information

NPI: 1477537157
Provider Name (Legal Business Name): AMY E YOUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY E WOLFE

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 W BIG BEAVER RD STE 1200
TROY MI
48084-4908
US

IV. Provider business mailing address

890 STANLEY BLVD
BIRMINGHAM MI
48009-1628
US

V. Phone/Fax

Practice location:
  • Phone: 248-273-7700
  • Fax: 248-273-7701
Mailing address:
  • Phone: 248-561-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301074308
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: