Provider Demographics
NPI:1245293323
Name:HENTGES, AMY SUE (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:SUE
Last Name:HENTGES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:11269 JEFFERSON HWY N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3123
Practice Address - Country:US
Practice Address - Phone:763-236-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN206031100Medicaid
MN1041310OtherPREFERRED ONE
MN833S9HEOtherBCBS OF MN
MN132025OtherUCARE MN
MN2156416OtherAMERICA'S PPO
MNHP42393OtherHEALTHPARTNERS
MN1202907OtherMEDICA
MN7069631OtherAETNA
MN6607779OtherMEDICA UC
MN1041310OtherPREFERRED ONE
MN206031100Medicaid