MEDICARE: FRANK P AMMESMAKI MD

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
1	207P00000X	Emergency Medicine Physician	5623	SD
2	207Q00000X	Family Medicine Physician	5623	SD
3	207P00000X	Emergency Medicine Physician	42378	AZ

General Provider Information

NPI Number	:	1710978176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK P AMMESMAKI MD

Provider Business Mailing Address
First Line	:	PO BOX 649
Second Line	:
City	:	FORT DEFIANCE
State	:	AZ
Zip	:	86504-0649
Country	:	US
Telephone Number	:	928-729-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	CORNER OF ROUTE N12 AND N7
Second Line	:
City	:	FORT DEFIANCE
State	:	AZ
Zip	:	86504-0649
Country	:	US
Telephone Number	:	928-729-8600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	11/22/2021

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Directions to “ FRANK P AMMESMAKI MD” Practice Location

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