Healthcare Provider Details

I. General information

NPI: 1447513148
Provider Name (Legal Business Name): AMANDA RUBUSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4775 E MARYLAND ST
DECATUR IL
62521-8820
US

IV. Provider business mailing address

4775 E MARYLAND ST
DECATUR IL
62521-8820
US

V. Phone/Fax

Practice location:
  • Phone: 217-864-3737
  • Fax: 217-864-3468
Mailing address:
  • Phone: 217-864-3737
  • Fax: 217-864-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036136464
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: