Individual
AMIRA MATTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23400 MICHIGAN AVE STE P40, DEARBORN, MI 48124-1928
(313) 689-5188
Mailing address
5438 HARTWELL ST, DEARBORN, MI 48126-3311
(313) 799-6833
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03302913
—
MI
Enumeration date
11/12/2017
Last updated
11/12/2017
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