Provider Demographics
NPI:1093743007
Name:TOBIN, AMY LUM (DO)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LUM
Last Name:TOBIN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:38731 MOUND ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3210
Mailing Address - Country:US
Mailing Address - Phone:586-939-8480
Mailing Address - Fax:586-939-8487
Practice Address - Street 1:38731 MOUND ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3210
Practice Address - Country:US
Practice Address - Phone:586-939-8480
Practice Address - Fax:586-939-8487
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101010948207RE0101X, 207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3290719/11Medicaid
MI0H26347OtherBCBS
MIG38020Medicare UPIN
MI0H26347Medicare ID - Type Unspecified