Provider Demographics
NPI:1902224215
Name:COUTURIER, AMY PATEL (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:PATEL
Last Name:COUTURIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 S GARFIELD AVE STE C
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3487
Mailing Address - Country:US
Mailing Address - Phone:231-714-4193
Mailing Address - Fax:952-333-7883
Practice Address - Street 1:802 S GARFIELD AVE STE C
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3487
Practice Address - Country:US
Practice Address - Phone:231-714-4193
Practice Address - Fax:952-333-7883
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA149706208000000X
MI4301503517208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics