Provider Demographics
NPI:1033295951
Name:INDORF, AMY (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:INDORF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 MERCY DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2614
Mailing Address - Country:US
Mailing Address - Phone:330-580-4706
Mailing Address - Fax:330-580-4707
Practice Address - Street 1:1320 MERCY DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2614
Practice Address - Country:US
Practice Address - Phone:330-580-4706
Practice Address - Fax:330-580-4707
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057637I207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1902827876OtherGROUP NPI
OH2157366OtherGROUP MEDICAID
OH0997131Medicaid
OH9303389OtherGROUP MEDICARE - MPCC
OH2157366OtherGROUP MEDICAID
OHIN0763661Medicare ID - Type Unspecified
1902827876OtherGROUP NPI