Basic Information
| Provider Information | |||||||||
| NPI: | 1427151067 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BISHNOI-SINGH | ||||||||
| FirstName: | AMITA | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1815 WYNGATE DR | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480986546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488282838 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 135 BARCLAY CIR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483074599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488522277 | ||||||||
| FaxNumber: | 2488522552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | AB072723 | MI | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | AB072723 | 01 | MI | LICENSE NIMBER | OTHER |