Provider Demographics
NPI:1093757148
Name:ECHELBERGER, AMY D (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:D
Last Name:ECHELBERGER
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 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-5085
Mailing Address - Fax:208-625-5731
Practice Address - Street 1:1300 E MULLAN AVE STE 1600
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854
Practice Address - Country:US
Practice Address - Phone:208-625-4965
Practice Address - Fax:208-625-4966
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM14042207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8882029OtherMEDICARE CORPORATION ID
WAP00734032OtherRAILROAD MEDICARE
WA7147259Medicaid
WAG8882028OtherMEDICARE INDIVIDUAL ID