Healthcare Provider Details

I. General information

NPI: 1194163139
Provider Name (Legal Business Name): FINN R. AMBLE, M.D. F.A.C.S., S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 EASTLAND DR SUITE 220
BLOOMINGTON IL
61701-3534
US

IV. Provider business mailing address

1505 EASTLAND DR SUITE 220
BLOOMINGTON IL
61701-3534
US

V. Phone/Fax

Practice location:
  • Phone: 309-662-2278
  • Fax:
Mailing address:
  • Phone: 309-662-2278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036090897
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number036090897
License Number StateIL

VIII. Authorized Official

Name: DR. AARON JAMES ROSSI
Title or Position: PRACTICE ADMINISTRATOR
Credential: M.D.
Phone: 309-662-2278