Provider Demographics
NPI:1285728022
Name:SIMANTEL, AMY L (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:SIMANTEL
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 1:100 N. WATER STREET
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:WI
Mailing Address - Zip Code:53502
Mailing Address - Country:US
Mailing Address - Phone:608-862-1616
Mailing Address - Fax:
Practice Address - Street 1:100 N. WATER STREET
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:WI
Practice Address - Zip Code:53502
Practice Address - Country:US
Practice Address - Phone:608-862-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43064207R00000X
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
12965OtherDEAN HEALTH PLAN
34152700OtherHIRSP
K13389OtherMEDICARE
14800226OtherMEDICARE PART B
WI34152700Medicaid
1038843OtherPHYSICIANS PLUS
390808509C1OtherUNITY
90002361OtherWEA INS
K13389OtherMEDICARE