Individual
AMOD S TOOTLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5220 HIGHLAND RD STE 200, WATERFORD, MI 48327-1973
(248) 334-3197
(248) 335-8857
Mailing address
5220 HIGHLAND RD STE 200, WATERFORD, MI 48327-1973
(248) 334-3197
(248) 335-8857
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4301031237
MI
208600000X
Surgery Physician
AT031237
MI
208C00000X
Colon & Rectal Surgery Physician
4301031237
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0639891
—
MI
05
—
2100453
—
MI
Enumeration date
01/12/2007
Last updated
01/31/2022
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