Healthcare Provider Details

I. General information

NPI: 1831307040
Provider Name (Legal Business Name): AMANDA CAMP WIELAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA KATHLEEN CAMP M.D.

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12631 E 17TH AVE # MSB-158
AURORA CO
80045-2527
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-1858
  • Fax: 303-724-1891
Mailing address:
  • Phone: 303-493-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberDR.0053799
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3660
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: