Provider Demographics
NPI:1760223176
Name:AMY MICELI DPM LLC
Entity type:Organization
Organization Name:AMY MICELI DPM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN LOUISE
Authorized Official - Last Name:MICELI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-439-1766
Mailing Address - Street 1:1312 STRAFFORD RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-6206
Mailing Address - Country:US
Mailing Address - Phone:717-439-1766
Mailing Address - Fax:
Practice Address - Street 1:PENN STATE HEALTH HOLY SPIRIT MEDICAL CENTER
Practice Address - Street 2:503 N. 21ST STREET
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2204
Practice Address - Country:US
Practice Address - Phone:717-763-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic MedicineGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Multi-Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty