Provider Demographics
NPI:1457862351
Name:AMANDA WINSTON MD PLLC
Entity Type:Organization
Organization Name:AMANDA WINSTON MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KALISZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-653-2111
Mailing Address - Street 1:9244 LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1757
Mailing Address - Country:US
Mailing Address - Phone:810-653-2111
Mailing Address - Fax:810-653-8506
Practice Address - Street 1:9244 LAPEER RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1757
Practice Address - Country:US
Practice Address - Phone:810-653-2111
Practice Address - Fax:810-653-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty