Provider Demographics
NPI:1871721209
Name:FISHER-HUBBARD, AMANDA OWEN (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:OWEN
Last Name:FISHER-HUBBARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:OWEN
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1301 CATHERINE
Mailing Address - Street 2:M5231E MSI
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5602
Mailing Address - Country:US
Mailing Address - Phone:734-764-3270
Mailing Address - Fax:
Practice Address - Street 1:1301 CATHERINE
Practice Address - Street 2:M5231E MSI
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5602
Practice Address - Country:US
Practice Address - Phone:734-764-3270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094351207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology