Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301102988 | MI |
Y | 2080P0202X | Pediatric Cardiologist | 4301102988 | MI |
NPI | 1255777876 |
---|---|
Provider Name | Amanda Delong Mccormick |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2013 |
Last Update Date | 10/07/2019 |