Provider Demographics
NPI:1366767162
Name:SPEECKAERT, AMY LYNNE (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:SPEECKAERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 570
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1579
Mailing Address - Country:US
Mailing Address - Phone:614-366-4263
Mailing Address - Fax:614-366-1814
Practice Address - Street 1:915 OLENTANGY RIVER RD FL 3
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212
Practice Address - Country:US
Practice Address - Phone:614-366-4263
Practice Address - Fax:614-366-1814
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY284961207XS0106X
OH35134046207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400152268Medicare PIN