Healthcare Provider Details

I. General information

NPI: 1366452229
Provider Name (Legal Business Name): AMANDA M WOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/29/2026
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 MCAULEY DR DEPT OF
YPSILANTI MI
48197-1051
US

IV. Provider business mailing address

2000 GREEN RD
ANN ARBOR MI
48105-1598
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-3002
  • Fax:
Mailing address:
  • Phone: 734-995-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberTL30698
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number2005023745
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: