Provider Demographics
NPI:1588976013
Name:ZILKA, AMANDA DYAN (PA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:DYAN
Last Name:ZILKA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:DYAN
Other - Last Name:ATTERBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1640 FORT ST
Mailing Address - Street 2:SUITE D ATTN DENISE
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2040
Mailing Address - Country:US
Mailing Address - Phone:734-391-3057
Mailing Address - Fax:734-391-3052
Practice Address - Street 1:15450 NORTHLINE RD
Practice Address - Street 2:STE 101
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2398
Practice Address - Country:US
Practice Address - Phone:734-282-2020
Practice Address - Fax:734-282-2002
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005727363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710315932OtherGROUP NPI HENRY FORD WYANDOTTE
MI0H28864OtherBLUE CROSS
MI0H28864OtherBLUE CROSS