Provider Demographics
NPI:1770770885
Name:AMIN, AMIR (COA,COF)
Entity type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:AMIN
Suffix:
Gender:M
Credentials:COA,COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24681 NORTHWESTER HWY, SUITE 103-A
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:313-404-1405
Mailing Address - Fax:
Practice Address - Street 1:24681 NORTHWESTER HWY, SUITE 103-A
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:313-404-1405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter