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General NPI Number Information
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NPI Number | 1275071763
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Entity Type | Individual
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Provider Name | ALEX MICHAEL AAMODT ATS
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Gender | Male
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 1 CAMPUS DR
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City | ALLENDALE
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State | MI
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Zip | 49401-9401
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Country | US
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Telephone | 231-855-2540
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Fax |
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Provider Business Mailing Address
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Address Line | 5121 PINE RIDGE DR
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City | NORTON SHORES
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State | MI
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Zip | 49441-5845
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Country | US
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Telephone | 231-855-5240
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | A530044603096
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License Number State | MI
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