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General NPI Number Information
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NPI Number | 1124549282
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Entity Type | Individual
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Provider Name | AMANDA MAHONEY MD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2017
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 37595 7 MILE RD STE 340
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City | LIVONIA
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State | MI
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Zip | 48152-1489
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Country | US
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Telephone | 734-793-2470
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Fax | 734-793-2471
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DR STE J2000
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City | ANN ARBOR
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State | MI
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Zip | 48105-9484
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Country | US
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Telephone | 734-747-6766
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2017022321
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301514025
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License Number State | MI
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