Individual
AMITA MAIBAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1542 MEDICAL PARK CIR, TUPELO, MS 38801-6560
(662) 844-4711
(662) 844-9619
Mailing address
1542 MEDICAL PARK CIR, TUPELO, MS 38801-6560
(662) 844-4711
(662) 844-9619
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
26530
MS
Other
Enumeration date
08/19/2015
Last updated
08/12/2019
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