Provider Demographics
NPI:1518902345
Name:AMIRIKIA, AREZO (MD)
Entity Type:Individual
Prefix:
First Name:AREZO
Middle Name:
Last Name:AMIRIKIA
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 1:3535 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0961
Mailing Address - Country:US
Mailing Address - Phone:248-931-9367
Mailing Address - Fax:
Practice Address - Street 1:44555 WOODWARD AVE STE 203
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5033
Practice Address - Country:US
Practice Address - Phone:248-334-4931
Practice Address - Fax:248-858-3993
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062398207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4376086Medicaid
7646123OtherAETNA
180044885OtherRAILROAD MEDICARE
MI1806340351OtherBCBS OF MICHIGAN PIN
MI4376086Medicaid
MI1806340351OtherBCBS OF MICHIGAN PIN
0F37294-004Medicare ID - Type Unspecified