Healthcare Provider Details

I. General information

NPI: 1518902998
Provider Name (Legal Business Name): MARY M AMON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 2ND ST SW SUITE 1
WILLMAR MN
56201-3365
US

IV. Provider business mailing address

502 2ND ST SW SUITE 1
WILLMAR MN
56201-3365
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-7232
  • Fax:
Mailing address:
  • Phone: 320-235-7232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37586
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: