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:
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Other - Credentials:
Mailing Address - Street 1:301 EXPLORER ST
Mailing Address - Street 2:
Mailing Address - City:GWINN
Mailing Address - State:MI
Mailing Address - Zip Code:49841-2813
Mailing Address - Country:US
Mailing Address - Phone:906-481-8586
Mailing Address - Fax:906-483-1394
Practice Address - Street 1:135 E M35
Practice Address - Street 2:
Practice Address - City:GWINN
Practice Address - State:MI
Practice Address - Zip Code:49841-9160
Practice Address - Country:US
Practice Address - Phone:906-346-9275
Practice Address - Fax:906-372-3230
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101010674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF36677Medicare UPIN