Provider Demographics
NPI:1417717760
Name:ALIJAGIC, AMRA (PA-C)
Entity Type:Individual
Prefix:
First Name:AMRA
Middle Name:
Last Name:ALIJAGIC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14051 LAKESIDE BLVD N
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-6074
Mailing Address - Country:US
Mailing Address - Phone:248-619-6247
Mailing Address - Fax:
Practice Address - Street 1:14051 LAKESIDE BLVD N
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-6074
Practice Address - Country:US
Practice Address - Phone:248-619-6247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601012319363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant