Provider Demographics
NPI:1366680167
Name:ERTEL, AMY KILEY (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:KILEY
Last Name:ERTEL
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 1:11686 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2804
Mailing Address - Country:US
Mailing Address - Phone:317-577-2777
Mailing Address - Fax:317-577-2954
Practice Address - Street 1:11686 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2804
Practice Address - Country:US
Practice Address - Phone:317-577-2777
Practice Address - Fax:317-577-2954
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049468A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice