Individual
AMANDA SU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-8632
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-2892
(313) 876-1305
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301511164
MI
207RG0100X
Gastroenterology Physician
Primary
4301511164
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/26/2018
Last updated
01/13/2025
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