Basic Information
| Provider Information | |||||||||
| NPI: | 1750499307 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PUTNAM | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6401 UNIVERSITY AVE NE | ||||||||
| Address2: | |||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554324341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635725710 | ||||||||
| FaxNumber: | 7635713008 | ||||||||
| Practice Location | |||||||||
| Address1: | 10000 ZANE AVE N | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554431400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635725710 | ||||||||
| FaxNumber: | 7635696200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 07/17/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 43230 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 43230 | MN | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1066911 | 01 | MN | AMERICA'S PPO | OTHER | 140079 | 01 | MN | UCARE MN | OTHER | 0402234 | 01 | MN | MEDICA | OTHER | 1024820 | 01 | MN | PREFERRED ONE | OTHER | 6603919 | 01 | MN | MEDICA URGENT CARE | OTHER | HP30909 | 01 | MN | HEALTHPARTNERS | OTHER | 7195170 | 01 | MN | AETNA INS | OTHER | 89D82PU | 01 | MN | BCBS OF MN | OTHER | 178427700 | 05 | MN | MEDICAID |