Provider Demographics
NPI:1124219175
Name:MASIH, AMIT KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:KUMAR
Last Name:MASIH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 JOLLY RD STE 240
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3681
Mailing Address - Country:US
Mailing Address - Phone:989-729-4304
Mailing Address - Fax:989-729-4308
Practice Address - Street 1:2525 JOLLY RD STE 240
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3681
Practice Address - Country:US
Practice Address - Phone:989-729-4304
Practice Address - Fax:989-729-4308
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010862552084B0040X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1124219175Medicaid
MIC36078030Medicare PIN