MEDICARE: AMY B JENTZ 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
1	208600000X	Surgery Physician	AJ076427	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1016881	OTHER	MI	MCLAREN
2	383218134	OTHER	MI	TRICARE
3	4791262	OTHER	MI	MOLINA
4	03004	OTHER	MI	PRIORITY HEALTH PAY TO #
5	700C460060	OTHER	MI	BCBS OF MI GROUP
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	200000002169	OTHER	MI	PHPMM

General Provider Information

NPI Number	:	1831204601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY B JENTZ M.D.

Provider Business Mailing Address
First Line	:	550 E WASHINGTON ST
Second Line	:
City	:	IONIA
State	:	MI
Zip	:	48846-2202
Country	:	US
Telephone Number	:	616-522-0714
Fax Number	:	616-522-0456

Provider Business Practice Location Address
First Line	:	550 E WASHINGTON ST
Second Line	:
City	:	IONIA
State	:	MI
Zip	:	48846-2202
Country	:	US
Telephone Number	:	616-523-1630
Fax Number	:	616-523-1631

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	04/09/2010

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Directions to “ AMY B JENTZ M.D.” Practice Location

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