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General NPI Number Information
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NPI Number | 1407305295
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Entity Type | Organization
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Legal Business Name | ISLAND MEDICAL HILLSDALE PLLC
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 168 S HOWELL ST
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City | HILLSDALE
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State | MI
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Zip | 49242-2040
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Country | US
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Telephone | 240-686-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 12420 MILESTONE CENTER DR STE 200
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City | GERMANTOWN
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State | MD
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Zip | 20876-7111
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Country | US
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Telephone | 240-686-2300
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Fax | 240-686-2329
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. AMY CHARLEY
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Credential | ESQ
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Telephone | 240-686-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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