Healthcare Provider Details

I. General information

NPI: 1255479523
Provider Name (Legal Business Name): CYNTHIA R AMBLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA ROSENBLAD

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 ROOSEVELT RD
GLEN ELLYN IL
60137-6141
US

IV. Provider business mailing address

885 ROOSEVELT RD
GLEN ELLYN IL
60137-6141
US

V. Phone/Fax

Practice location:
  • Phone: 630-790-1555
  • Fax: 630-545-3787
Mailing address:
  • Phone: 630-790-1555
  • Fax: 630-545-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036093463
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: