Provider Demographics
NPI:1851704936
Name:CONSSON, AMY MICHELE ENTERLINE (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELE ENTERLINE
Last Name:CONSSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2975 MAX AVE # 1187
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7143
Mailing Address - Country:US
Mailing Address - Phone:406-414-0020
Mailing Address - Fax:888-289-4505
Practice Address - Street 1:62 TILLYFOUR RD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-9666
Practice Address - Country:US
Practice Address - Phone:406-414-0020
Practice Address - Fax:888-289-4505
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-87487207R00000X
MTMED-RES-LIC-58297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine