Basic Information
| Provider Information | |||||||||
| NPI: | 1366094435 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMAN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | LEONARD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27483 DEQUINDRE RD STE 302 | ||||||||
| Address2: | |||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480715715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489677769 | ||||||||
| FaxNumber: | 2485475696 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 BARCLAY CIR STE 100 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483074599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488522277 | ||||||||
| FaxNumber: | 8335334924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2019 | ||||||||
| LastUpdateDate: | 04/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 4704293315 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.