Provider Demographics
NPI:1225082548
Name:FONG, AMY SHIH-MEI (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:SHIH-MEI
Last Name:FONG
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 1:1500 NEELY AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47306-0001
Mailing Address - Country:US
Mailing Address - Phone:765-285-8431
Mailing Address - Fax:
Practice Address - Street 1:1500 NEELY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47306-0001
Practice Address - Country:US
Practice Address - Phone:765-285-8431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269475100Medicaid
FL37933ZMedicare PIN
I04835Medicare UPIN