Provider Demographics
NPI:1457648008
Name:AMY KILEY ERTEL, MD
Entity Type:Organization
Organization Name:AMY KILEY ERTEL, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KILEY
Authorized Official - Last Name:ERTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-577-2777
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049468A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty