Provider Demographics
NPI:1750499307
Name:PUTNAM, AMY M (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:10000 ZANE AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1400
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-569-6200
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN43230207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1066911OtherAMERICA'S PPO
MN140079OtherUCARE MN
MN0402234OtherMEDICA
MN1024820OtherPREFERRED ONE
MN6603919OtherMEDICA URGENT CARE
MNHP30909OtherHEALTHPARTNERS
MN7195170OtherAETNA INS
MN89D82PUOtherBCBS OF MN
MN178427700Medicaid
MN0402234OtherMEDICA
MN89D82PUOtherBCBS OF MN