Provider Demographics
NPI:1912015561
Name:LASSIG, AMY ANNE DONATELLI (MD)
Entity Type:Individual
Prefix:
First Name:AMY ANNE
Middle Name:DONATELLI
Last Name:LASSIG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:UNIV OF MINNESOTA DEPT OF OTO, LIONS 5M HEARING CENTER
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:UNIV OF MINNESOTA DEPT OF OTO, LIONS 5M HEARING CENTER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-625-9996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301078065207Y00000X
MN49555207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology