Provider Demographics
NPI:1588031280
Name:AMITY INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:AMITY INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:RAQUEL
Authorized Official - Last Name:RUSSELL-LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-721-6312
Mailing Address - Street 1:31500 TELEGRAPH RD STE 240
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4315
Mailing Address - Country:US
Mailing Address - Phone:248-792-3690
Mailing Address - Fax:248-792-3689
Practice Address - Street 1:31500 TELEGRAPH RD STE 240
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4315
Practice Address - Country:US
Practice Address - Phone:248-792-3690
Practice Address - Fax:248-792-3689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty