Healthcare Provider Details

I. General information

NPI: 1932842168
Provider Name (Legal Business Name): AMULYA R. DWARAM M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 W DEMPSTER ST STE 525
PARK RIDGE IL
60068-1130
US

IV. Provider business mailing address

1875 W DEMPSTER ST STE 525
PARK RIDGE IL
60068-1130
US

V. Phone/Fax

Practice location:
  • Phone: 847-698-5500
  • Fax:
Mailing address:
  • Phone: 847-698-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036.174088
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125079972
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: