Provider Demographics
NPI:1972828770
Name:MASOWICK, AMY E (DPM)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:MASOWICK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:32743 23 MILE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2176
Mailing Address - Country:US
Mailing Address - Phone:708-424-3201
Mailing Address - Fax:708-424-5001
Practice Address - Street 1:5914 WOLFPEN PLEASANT HILL RD STE E
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-3078
Practice Address - Country:US
Practice Address - Phone:513-831-7503
Practice Address - Fax:513-831-7923
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003648213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0101293Medicaid
OHH22670Medicare PIN