Provider Demographics
NPI:1841362506
Name:MAVANI, AMI K (MD)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:K
Last Name:MAVANI
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 1:101 ROCHDALE DR S
Mailing Address - Street 2:STE B
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2273
Mailing Address - Country:US
Mailing Address - Phone:248-650-5009
Mailing Address - Fax:248-652-9557
Practice Address - Street 1:101 ROCHDALE DR S
Practice Address - Street 2:STE B
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-2273
Practice Address - Country:US
Practice Address - Phone:248-650-5009
Practice Address - Fax:248-652-9557
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081891174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH60339Medicare UPIN