Healthcare Provider Details

I. General information

NPI: 1508890732
Provider Name (Legal Business Name): AMY KAY GREMINGER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 OAKDALE AVE N
ROBBINSDALE MN
55422
US

IV. Provider business mailing address

ESSENTIA HEALTH 400 EAST THIRD STREET MCL2CRED
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 763-520-2827
  • Fax: 763-520-1022
Mailing address:
  • Phone: 218-786-8319
  • Fax: 218-722-8792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46733
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number46733
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: