MEDICARE: AMELIA MANCINI

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	207Q00000X	Family Medicine Physician	5605227456	MI
2	363A00000X	Physician Assistant		MI

General Provider Information

NPI Number	:	1447848304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA MANCINI

Provider Business Mailing Address
First Line	:	1701 SOUTH BLVD E STE 150
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6115
Country	:	US
Telephone Number	:	248-997-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 SOUTH BLVD E STE 150
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6115
Country	:	US
Telephone Number	:	248-997-7000
Fax Number	:

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

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	02/15/2023

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Directions to “ AMELIA MANCINI ” Practice Location

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