Provider Demographics
NPI:1669856985
Name:BENNETT, AMY K (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:K
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13001 COUNTY ROAD 10
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1124
Mailing Address - Country:US
Mailing Address - Phone:763-509-4282
Mailing Address - Fax:763-519-2367
Practice Address - Street 1:13001 COUNTY ROAD 10
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-1124
Practice Address - Country:US
Practice Address - Phone:763-509-4282
Practice Address - Fax:763-519-2367
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN36986207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine