Provider Demographics
NPI:1407908387
Name:JELINEK, AMY M (DPM)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:JELINEK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-0236
Mailing Address - Country:US
Mailing Address - Phone:812-932-3371
Mailing Address - Fax:812-932-3506
Practice Address - Street 1:256 STATE ROAD 129 S
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-9236
Practice Address - Country:US
Practice Address - Phone:812-932-4700
Practice Address - Fax:812-933-5144
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001032A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN251370AOtherMEDICARE - DEACTIVATED 5/13/2013
IN201152310Medicaid
IN251370AOtherMEDICARE - DEACTIVATED 5/13/2013