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NPI Code Detail

MEDICARE: DR. AMY LOUISE REDMER MD

MEDICARE: DR. AMY LOUISE REDMER 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 PhysicianMD11614RI
2207Q00000XFamily Medicine Physician036155300IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MD11614OTHERRISTATE LICENSE

General Provider Information

NPI Number : 1982676698
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMY LOUISE REDMER MD
Provider Business Mailing Address
First Line : PO BOX 387
Second Line :
City : CALPELLA
State : CA
Zip : 95418-0387
Country : US
Telephone Number : 707-485-5115
Fax Number : 707-485-7792
Provider Business Practice Location Address
First Line : 1116 HARTMAN LN
Second Line :
City : SHILOH
State : IL
Zip : 62221-8014
Country : US
Telephone Number : 618-641-9011
Fax Number : 618-641-9017
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2006
Last Update Date : 03/07/2023

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