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NPI Code Detail

MEDICARE: KELLY R AMANN DO

MEDICARE: KELLY R AMANN DO
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 Physician49040751204UT

General Provider Information

NPI Number : 1134116783
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY R AMANN DO
Provider Business Mailing Address
First Line : PO BOX 5546
Second Line :
City : DENVER
State : CO
Zip : 80217-5546
Country : US
Telephone Number : 801-475-3900
Fax Number : 801-475-3901
Provider Business Practice Location Address
First Line : 3485 W 5200 S
Second Line :
City : ROY
State : UT
Zip : 84067-9438
Country : US
Telephone Number : 801-475-3900
Fax Number : 801-475-3901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2005
Last Update Date : 01/17/2017

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