Basic Information
| Provider Information | |||||||||
| NPI: | 1578558680 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMIN | ||||||||
| FirstName: | ALTAMASH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9900 BIRCH RUN RD | ||||||||
| Address2: | |||||||||
| City: | BIRCH RUN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484159609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896241500 | ||||||||
| FaxNumber: | 9896241506 | ||||||||
| Practice Location | |||||||||
| Address1: | 3150 HALLMARK CT | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486032173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897934420 | ||||||||
| FaxNumber: | 9897938577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 04/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301062214 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4601340 | 05 | MI | MEDICAID |