Provider Demographics
NPI:1871529115
Name:AMJADI, ERIN MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MICHELLE
Last Name:AMJADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7000 NORTH MOPAC
Mailing Address - Street 2:SUITE #420
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-482-0045
Mailing Address - Fax:512-476-9892
Practice Address - Street 1:7000 NORTH MOPAC
Practice Address - Street 2:SUITE #420
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-482-0045
Practice Address - Fax:512-476-9892
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL4724207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137170007Medicaid
TX1371700-07Medicaid
TX137170007Medicaid
TX1371700-07Medicaid
TXTXB140791Medicare PIN
TX8A1576Medicare PIN
TXH28572Medicare UPIN