Provider Demographics
NPI:1518902998
Name:AMON, MARY M (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:AMON
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 1:502 2ND ST SW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3365
Mailing Address - Country:US
Mailing Address - Phone:320-235-7232
Mailing Address - Fax:
Practice Address - Street 1:502 2ND ST SW
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3365
Practice Address - Country:US
Practice Address - Phone:320-235-7232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37586207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN325101845OtherPRIME WEST
MN526818400Medicaid
MNHP21638OtherHEALTH PARTNERS
MN01-01066OtherMEDICA
MN080062303OtherRR MEDICARE
MN114458OtherU CARE
MNMR1081007927OtherPREFERRED ONE
MN1048378OtherARAZ
MN6T223AMOtherBLUE CROSS BLUE SHIELD
MNMR1081007927OtherPREFERRED ONE
MN089002728Medicare ID - Type Unspecified