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NPI Code Detail

MEDICARE: DR. AMY J ELLIOTT M.D.

MEDICARE: DR. AMY J ELLIOTT 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
1207Q00000XFamily Medicine PhysicianC1-0006359DE
2207Q00000XFamily Medicine Physician41288MN

General Provider Information

NPI Number : 1841281904
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMY J ELLIOTT M.D.
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-5000
Fax Number :
Provider Business Practice Location Address
First Line : 100 STATE AVE
Second Line :
City : FARIBAULT
State : MN
Zip : 55021-6337
Country : US
Telephone Number : 507-334-3921
Fax Number : 507-332-6668
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2005
Last Update Date : 03/11/2021

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