Healthcare Provider Details

I. General information

NPI: 1023169570
Provider Name (Legal Business Name): NILAM K. AMIN, D.O., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N HALSTED ST SUITE #505
CHICAGO IL
60642-2605
US

IV. Provider business mailing address

1460 N HALSTED ST SUITE #505
CHICAGO IL
60642-2605
US

V. Phone/Fax

Practice location:
  • Phone: 312-266-6462
  • Fax: 312-266-6481
Mailing address:
  • Phone: 312-266-6462
  • Fax: 312-266-6481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036115389
License Number StateIL

VIII. Authorized Official

Name: DR. NILAM KIRAN AMIN
Title or Position: OWNER
Credential: D.O.
Phone: 312-266-6462