Basic Information
| Provider Information | |||||||||
| NPI: | 1821226432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIONDICH | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12500 WEST BLUEMOUND RD | ||||||||
| Address2: | |||||||||
| City: | ELM GROVE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53122 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1575 BEAM AVE | ||||||||
| Address2: | |||||||||
| City: | MAPLEWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551091126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512327000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2009 | ||||||||
| LastUpdateDate: | 06/07/2017 | ||||||||
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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 | 208600000X | LL31745 | SC | N | Allopathic & Osteopathic Physicians | Surgery | 207P00000X | 61356-20 | WI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.