MEDICARE: SVETLANA O AMINOVA MD

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
1	207RI0200X	Infectious Disease Physician	4301080284	MI

General Provider Information

NPI Number	:	1063577625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SVETLANA O AMINOVA MD

Provider Business Mailing Address
First Line	:	PO BOX 71011
Second Line	:
City	:	ROCHESTER HLS
State	:	MI
Zip	:	48307-0019
Country	:	US
Telephone Number	:	248-879-2836
Fax Number	:	248-551-1110

Provider Business Practice Location Address
First Line	:	1701 SOUTH BLVD E
Second Line	:	SUITE 160
City	:	ROCHESTER HLS
State	:	MI
Zip	:	48307-6122
Country	:	US
Telephone Number	:	248-598-5080
Fax Number	:	248-598-5080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	02/26/2008

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