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AMANDA NOELLE DESPART MD
NPI 1407786171
Student in an Organized Health Care Education/Training Program in Canton, MI

Active since May 22, 2026PECOS Enrolled
1051 N CANTON CENTER RD, CANTON, MI 48187(734) 539-5080 Get Directions Write a Review

NPPES record last updated: May 22, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Amanda Noelle Despart Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AMANDA NOELLE DESPART MD (NPI 1407786171) is an individual student in an organized health care education/training program in Canton, Michigan, licensed in Michigan (4351055600) and active in the NPI registry since May 2026. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1407786171
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameAMANDA NOELLE DESPARTCredential: MD
Location Address1051 N CANTON CENTER RDCanton, MI 48187-5097
Mailing Address1200 E Hospital Dr., D3230Ann Arbor, MI 48109 · (734) 647-1774
Phone(734) 539-5080
Sole ProprietorNo
Enumeration DateMay 22, 2026
NPPES CertifiedMay 15, 2026
✔ NPI 1407786171 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
License✔ Licensed in MI · 4351055600
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1051 N CANTON CENTER RD, Canton, MI 48187
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Amanda Noelle Despart Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GENEVIEVE ALLEN MD
Student in an Organized Health Care Education/Training Program
1051 N CANTON CENTER RD
CANTON, MI 48187
Wayne County (734) 844-5400
GAVRIELLE ROOD
Student in an Organized Health Care Education/Training Program
1051 N CANTON CENTER RD
CANTON, MI 48187
Wayne County (734) 647-5670
KATHERINE ELIZABETH CHAMBERS MD
Student in an Organized Health Care Education/Training Program
1051 N CANTON CENTER RD
CANTON, MI 48187
Wayne County (734) 539-5080
CAROLINE STROMBERG
Student in an Organized Health Care Education/Training Program
1051 N CANTON CENTER RD
CANTON, MI 48187
Wayne County (734) 647-1774
ALISSA ANASTASIO DO
Student in an Organized Health Care Education/Training Program
1051 N CANTON CENTER RD
CANTON, MI 48187
Wayne County (734) 844-5400
STANA NICKOLICH MD
Student in an Organized Health Care Education/Training Program
1051 N CANTON CENTER RD
CANTON, MI 48187
Wayne County (734) 647-5670
NATHAN BATRES MD
Student in an Organized Health Care Education/Training Program
1051 N CANTON CENTER RD
CANTON, MI 48187
Wayne County (734) 998-2020
CULLEN DURKIN FARRAGHER DO
Student in an Organized Health Care Education/Training Program
1051 N CANTON CENTER RD
CANTON, MI 48187
Wayne County (734) 539-5080

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Amanda Despart's NPI number?

The NPI number for Amanda Despart is 1407786171. It was assigned to this individual provider in the NPPES registry on May 22, 2026.

Where is Amanda Despart located?

Amanda Despart practices at 1051 N Canton Center Rd, Canton, MI 48187. The listed phone number is (734) 539-5080.

What is Amanda Despart's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Amanda Despart enrolled in Medicare?

Yes. Amanda Despart is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Amanda Despart was last updated on May 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.