Healthcare Provider Details

I. General information

NPI: 1366094435
Provider Name (Legal Business Name): MATTHEW LEONARD AMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 LIVERNOIS RD STE 275
TROY MI
48083-5034
US

IV. Provider business mailing address

3150 LIVERNOIS RD STE 275
TROY MI
48083-5034
US

V. Phone/Fax

Practice location:
  • Phone: 248-853-0803
  • Fax:
Mailing address:
  • Phone: 248-853-0803
  • Fax: 248-852-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704293315
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704293315
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: