Healthcare Provider Details

I. General information

NPI: 1740369917
Provider Name (Legal Business Name): AMAR MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 MYRTLE AVE
GRANITE CITY IL
62040-5012
US

IV. Provider business mailing address

3165 MYRTLE AVE
GRANITE CITY IL
62040-5012
US

V. Phone/Fax

Practice location:
  • Phone: 618-877-3066
  • Fax: 618-877-3060
Mailing address:
  • Phone: 618-877-3066
  • Fax: 618-877-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. PRASANNA C KUMAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 618-877-3066