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NPI Code Detail

MEDICARE: AMY ELLINGSON MD

MEDICARE: AMY ELLINGSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician71609MN
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1154950483
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY ELLINGSON MD
Provider Business Mailing Address
First Line : 2220 PLYMOUTH AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-3600
Country : US
Telephone Number : 612-543-2500
Fax Number :
Provider Business Practice Location Address
First Line : 2220 PLYMOUTH AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-3600
Country : US
Telephone Number : 612-543-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2020
Last Update Date : 12/07/2023

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