Basic Information
| Provider Information | |||||||||
| NPI: | 1922200070 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARKS | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | LAUREN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 ST. ANTOINE UHC 6F MAILBOX# 226 | ||||||||
| Address2: | UNIVERSITY PEDIATRICIANS | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139665051 | ||||||||
| FaxNumber: | 3139666618 | ||||||||
| Practice Location | |||||||||
| Address1: | 3535 W 13 MILE RD STE 305 | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480736770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485513070 | ||||||||
| FaxNumber: | 2485513071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 10/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 5101018682 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0201X | 5101018682 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology |
No ID Information.