Healthcare Provider Details

I. General information

NPI: 1619907995
Provider Name (Legal Business Name): NILAM KIRAN AMIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
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 Number036-115389
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: