Provider Demographics
NPI:1528097649
Name:NOFFKE, AMY ROSE S (MD)
Entity type:Individual
Prefix:DR
First Name:AMY ROSE
Middle Name:S
Last Name:NOFFKE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:39650 ORCHARD HILL PL
Mailing Address - Street 2:200
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5391
Mailing Address - Country:US
Mailing Address - Phone:248-319-0161
Mailing Address - Fax:248-319-0170
Practice Address - Street 1:860 EAST FRONT STREET
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2704
Practice Address - Country:US
Practice Address - Phone:231-938-0710
Practice Address - Fax:231-938-0264
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2014-05-16
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Provider Licenses
StateLicense IDTaxonomies
MI4301077476207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4303704Medicaid
OM21980019Medicare ID - Type Unspecified
H19827Medicare UPIN
H19827Medicare UPIN