Provider Demographics
NPI:1396560132
Name:GLOVER, AMEYA SEMORA (BD)
Entity type:Individual
Prefix:
First Name:AMEYA
Middle Name:SEMORA
Last Name:GLOVER
Suffix:
Gender:F
Credentials:BD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17950 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-2260
Mailing Address - Country:US
Mailing Address - Phone:313-401-0929
Mailing Address - Fax:
Practice Address - Street 1:17950 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-2260
Practice Address - Country:US
Practice Address - Phone:313-401-0929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator