Individual
AMANDA KISCHUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6245 INKSTER RD, GARDEN CITY, MI 48135-4001
(734) 458-3300
Mailing address
3044 LINCOLN ST, DEARBORN, MI 48124-3504
(313) 570-4271
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1040941
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1040941
CDR NUMBER
MI
Enumeration date
07/17/2012
Last updated
07/17/2012
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