=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255644902
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA BREE SALTER MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2010
-----------------------------------------------------
Last Update Date | 03/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31700 TELEGRAPH RD STE 140
-----------------------------------------------------
City | BINGHAM FARMS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48025-3466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-688-0234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31700 TELEGRAPH RD STE 140
-----------------------------------------------------
City | BINGHAM FARMS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48025-3466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-688-0234
-----------------------------------------------------
Fax | 248-780-6071
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 4301096080
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------