Individual
DR. AMY D CVENGROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
440 WOODWARD AVE, IRON MOUNTAIN, MI 49801-4631
(906) 776-9040
(906) 774-5950
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301507438
MI
207R00000X
Internal Medicine Physician
51856
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
450030815
MEDICARE PTAN
WI
01
—
711290211
MEDICARE PTAN
WI
Enumeration date
11/01/2006
Last updated
10/05/2022
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