Individual
DR. MARYELLEN A AMATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2865
(417) 820-7865
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
R4C09
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82709
AR BLUE SHIELD #
MO
Enumeration date
02/16/2007
Last updated
07/09/2007
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