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NPI Code Detail

MEDICARE: DR. AMANDA MARIE EVERHART M.D.

MEDICARE:  DR. AMANDA MARIE EVERHART  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 Physician49714MN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00438360OTHERRR MEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11851513865OTHERMEDICA
216P75EVOTHERMNBCBS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851513865
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMANDA MARIE EVERHART 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 : 21260 CHIPPENDALE AVE W
Second Line :
City : FARMINGTON
State : MN
Zip : 55024-1427
Country : US
Telephone Number : 651-463-7181
Fax Number : 651-241-0829
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 11/10/2020

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