Individual
AMY INDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1320 MERCY DR NW, CANTON, OH 44708-2614
(330) 580-4706
(330) 580-4707
Mailing address
1320 MERCY DR NW, CANTON, OH 44708-2614
(330) 580-4706
(330) 580-4707
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
35057637I
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0997131
—
OH
01
—
1902827876
GROUP NPI
—
01
—
2157366
GROUP MEDICAID
OH
01
—
9303389
GROUP MEDICARE - MPCC
OH
Enumeration date
10/31/2006
Last updated
02/01/2010
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