Provider Demographics
NPI:1396781985
Name:CONNELL, AMY M (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:CONNELL
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 1:1717 CENTER AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-2818
Mailing Address - Country:US
Mailing Address - Phone:608-743-2258
Mailing Address - Fax:608-757-5858
Practice Address - Street 1:1717 CENTER AVE STE 260
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-2818
Practice Address - Country:US
Practice Address - Phone:608-743-2258
Practice Address - Fax:608-757-5858
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2025-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43685-0202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1396781985Medicaid
WIP01671770OtherRAILROAD MEDICARE
WIP01671770OtherRAILROAD MEDICARE
WI34543100Medicaid
I13144Medicare UPIN