Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 4301502178 | MI |
NPI | 1659784718 |
---|---|
Provider Name | Dr. Amy Anna Eapen |
First Address | Dearborn, MI 48126-2641 |
Second Address | Dearborn, MI 48126-2641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2014 |
Last Update Date | 21/05/2020 |