Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 5101018682 | MI |
Y | 2080P0201X | Pediatric Allergist | 5101018682 | MI |
NPI | 1922200070 |
---|---|
Provider Name | Amy Lauren Marks |
First Address | Detroit, MI 48201 |
Second Address | Royal Oak, MI 48073-6770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 23/10/2020 |