Provider Demographics
NPI:1356449474
Name:MANOLIS, AMY L (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:MANOLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3955 PARKLAWN AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5655
Mailing Address - Country:US
Mailing Address - Phone:952-831-1944
Mailing Address - Fax:952-278-6947
Practice Address - Street 1:501 E NICOLLET BLVD
Practice Address - Street 2:STE 200
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6732
Practice Address - Country:US
Practice Address - Phone:952-831-1944
Practice Address - Fax:952-278-6947
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN34637208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1213059OtherMEDICA
MNFP9021016291OtherPREFERRED ONE
MN9G969MAOtherBC/BS
MN1213059OtherMEDICA