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General NPI Number Information
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NPI Number | 1992133144
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Entity Type | Individual
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Provider Name | AMANI TANIOS PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/25/2013
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Last Update Date | 03/15/2019
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Provider Practice Location Address
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Address Line | 22201 MOROSS RD SUITE 170
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City | DETROIT
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State | MI
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Zip | 48236-2169
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Country | US
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Telephone | 586-247-4300
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Fax | 586-532-6496
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Provider Business Mailing Address
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Address Line | 813 MERCER CT
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-3091
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Country | US
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Telephone | 248-563-6104
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601006854
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License Number State | MI
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