MEDICARE: DR. AMBIKA P AMBLEE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036-100948	IL
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	036-100948	IL

General Provider Information

NPI Number	:	1225090590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBIKA P AMBLEE MD

Provider Business Mailing Address
First Line	:	25 AMBRIANCE DR
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-6498
Country	:	US
Telephone Number	:	312-731-1220
Fax Number	:	312-864-9734

Provider Business Practice Location Address
First Line	:	1901 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3714
Country	:	US
Telephone Number	:	312-864-6519
Fax Number	:	312-864-9734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	04/21/2021

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