| Doctor Name: | MS. AMANDA RAE DOUBLEDAY |
| NPI Number: | 1114212123 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DO, MBA |
| License Number: | 5101019478 |
| Business Practice Address: | 36475 Five Mile Rd Livonia, MI - 481541971 |
| Business Phone Number: | 7346554800 |
| Business Fax Number: | |
| Mailing Address: | 438 W 11th St, KANSAS CITY |
| State: | MO |
| Postal Code: | 641052227 |
| Phone Number: | 2624902838 |
| Fax Number: | |
| NPI Enumeration Date: | 06/17/2011 |
| NPI Last Update Date: | 06/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 5101019478 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |