Provider Demographics
NPI:1497716112
Name:MIKHAIL, AMY PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:PATRICIA
Last Name:MIKHAIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 VALLEYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9362
Mailing Address - Country:US
Mailing Address - Phone:734-480-9672
Mailing Address - Fax:
Practice Address - Street 1:911 BROWN ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3203
Practice Address - Country:US
Practice Address - Phone:734-769-3702
Practice Address - Fax:734-769-2075
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010714792080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF06422Medicare UPIN
MIF06422Medicare ID - Type Unspecified