Basic Information
| Provider Information | |||||||||
| NPI: | 1619306404 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMI MEDICAL ASSOCIATES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31313 NORTHWESTERN HWY STE 203 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483342577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488800123 | ||||||||
| FaxNumber: | 2484795030 | ||||||||
| Practice Location | |||||||||
| Address1: | 31313 NORTHWESTERN HWY STE 203 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483342577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488800123 | ||||||||
| FaxNumber: | 2484795030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2013 | ||||||||
| LastUpdateDate: | 12/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | IBRAHIM | ||||||||
| AuthorizedOfficialFirstName: | FADI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2488800123 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301092978 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.