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NPI Code Detail

MEDICARE: AMY L FAIR M.D.

MEDICARE:   AMY L FAIR  M.D.
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
1208000000XPediatrics Physician46737MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245204346
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY L FAIR M.D.
Provider Business Mailing Address
First Line : 290 MAIN STREET
Second Line : SUITE 100
City : ELK RIVER
State : MN
Zip : 55330
Country : US
Telephone Number : 763-241-5805
Fax Number : 763-241-5835
Provider Business Practice Location Address
First Line : 290 MAIN ST NW
Second Line : SUITE 100
City : ELK RIVER
State : MN
Zip : 55330-1270
Country : US
Telephone Number : 763-241-5805
Fax Number : 763-241-5835
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 07/06/2010

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Directions to “ AMY L FAIR M.D.” Practice Location

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