Provider Demographics
NPI:1952085094
Name:AMAL, TANYA (MBBS)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:AMAL
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 W, 13 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-551-3000
Mailing Address - Fax:248-551-9425
Practice Address - Street 1:3601 W, 13 MILE ROAD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-551-3000
Practice Address - Fax:248-551-9425
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2024-01-16
Deactivation Date:2024-01-12
Deactivation Code:
Reactivation Date:2024-01-16
Provider Licenses
StateLicense IDTaxonomies
MI4351051304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine