Healthcare Provider Details

I. General information

NPI: 1952581373
Provider Name (Legal Business Name): AMIE J GAMINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMIE J TUCKER MD

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST SUITE 054
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

1725 W HARRISON ST SUITE 054
CHICAGO IL
60612-3841
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6744
  • Fax: 312-942-3131
Mailing address:
  • Phone: 312-942-6744
  • Fax: 312-942-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-118579
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036-118579
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: