Provider Demographics
NPI:1982796488
Name:TOOLE, AMANDA J (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:J
Last Name:TOOLE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:21000 E 12 MILE RD
Mailing Address - Street 2:STE 111
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081
Mailing Address - Country:US
Mailing Address - Phone:586-226-4301
Mailing Address - Fax:586-445-2523
Practice Address - Street 1:21000 E 12 MILE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081
Practice Address - Country:US
Practice Address - Phone:586-779-7610
Practice Address - Fax:586-445-2523
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-10-05
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Provider Licenses
StateLicense IDTaxonomies
MIAT077352207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
104263OtherGREAT LAKES
H31309OtherHEALTH ALLIANCE PLAN
7246248OtherAETNA
C7547OtherMCAR
0405011091OtherBLUE CROSS BLUE SHIELD
131198OtherCARE CHOICES
4112028002OtherCIGNA
0501109OtherBLUE CARE NETWORK
MI4284574Medicaid
0405011091OtherBLUE CROSS BLUE SHIELD
H31309OtherHEALTH ALLIANCE PLAN