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NPI Code Detail

MEDICARE: AMANDA FIFFICK

MEDICARE: AMANDA FIFFICK
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
1363A00000XPhysician Assistant50.004718RXOH

General Provider Information

NPI Number : 1679923684
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA FIFFICK
Provider Business Mailing Address
First Line : 2049 E 100TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-2104
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2049 E 100TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-2104
Country : US
Telephone Number : 216-445-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2016
Last Update Date : 06/21/2016

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Directions to “ AMANDA FIFFICK ” Practice Location

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