Provider Demographics
NPI:1760129076
Name:MAHMOODZADEH KHOEI, AMELIA AYNAZ
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:AYNAZ
Last Name:MAHMOODZADEH KHOEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E MEDICAL CENTER DR.
Mailing Address - Street 2:TAUBMAN CENTER, 2ND FLOOR, RECEPTION C
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5330
Mailing Address - Country:US
Mailing Address - Phone:734-936-7030
Mailing Address - Fax:734-936-9127
Practice Address - Street 1:1500 E MEDICAL CENTER DR.
Practice Address - Street 2:TAUBMAN CENTER, 2ND FLOOR, RECEPTION C
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5330
Practice Address - Country:US
Practice Address - Phone:734-936-7030
Practice Address - Fax:734-936-9127
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351048895390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program