Individual
AMANDA M BASIL-PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
25631 LITTLE MACK AVE STE 205, SAINT CLAIR SHORES, MI 48081-2108
(586) 443-2380
(586) 443-2935
Mailing address
26901 BEAUMONT BLVD, SOUTHFIELD, MI 48033-3849
(248) 577-3313
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601009765
MI
363A00000X
Physician Assistant
MA057154
PA
Other
Enumeration date
07/06/2015
Last updated
01/19/2021
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