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NPI Code Detail

MEDICARE: MITUAL AMIN

MEDICARE: MITUAL AMIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician4301067551MI
2207ZP0101XAnatomic Pathology Physician4301067551MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1220F349850OTHERMIBCBSM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053389171
Entity Type Code : Individual
Provider Name (Legal Business Name) : MITUAL AMIN
Provider Business Mailing Address
First Line : 2344 TALL OAKS DR
Second Line :
City : TROY
State : MI
Zip : 48098-2400
Country : US
Telephone Number : 248-943-3963
Fax Number :
Provider Business Practice Location Address
First Line : 1701 SOUTH BLVD E STE 300
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48307-6120
Country : US
Telephone Number : 248-884-9710
Fax Number : 248-884-9711
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 02/18/2026

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Directions to “ MITUAL AMIN ” Practice Location

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