Healthcare Provider Details

I. General information

NPI: 1669486668
Provider Name (Legal Business Name): ANTHONY ORIA AMIEWALAN I MD FACOG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANTHONY ORIA AMIE I MD

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 EAST LAKE SHORE DR SUITE 320
DECATUR IL
62521
US

IV. Provider business mailing address

2965 N MAIN ST STE A2969N
DECATUR IL
62526-4392
US

V. Phone/Fax

Practice location:
  • Phone: 217-422-0560
  • Fax: 217-422-0872
Mailing address:
  • Phone: 217-422-0560
  • Fax: 217-422-0872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number036112019
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036112019
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: