Provider Demographics
NPI:1962847764
Name:MELTZER, AMY
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:MELTZER
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 1:41935 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3120
Mailing Address - Country:US
Mailing Address - Phone:248-347-8040
Mailing Address - Fax:248-305-6179
Practice Address - Street 1:41935 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3120
Practice Address - Country:US
Practice Address - Phone:248-347-8040
Practice Address - Fax:248-305-6179
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063910208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics