Provider Demographics
NPI:1831140409
Name:AMELON, MITZI COLLEEN (DO)
Entity Type:Individual
Prefix:DR
First Name:MITZI
Middle Name:COLLEEN
Last Name:AMELON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-4114
Mailing Address - Fax:989-583-1349
Practice Address - Street 1:2919 WILDER RD STE 150
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9602
Practice Address - Country:US
Practice Address - Phone:989-671-5757
Practice Address - Fax:989-671-5775
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF36677Medicare UPIN