Individual
AMY G. CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
22255 GREENFIELD RD STE 590, SOUTHFIELD, MI 48075-3734
(248) 849-4990
(248) 849-4991
Mailing address
7348 RAFFORD LN, WEST BLOOMFIELD, MI 48322-3190
(248) 592-0733
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601002695
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00191570
RAILROAD MEDICARE
—
Enumeration date
10/01/2005
Last updated
09/11/2024
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