Healthcare Provider Details

I. General information

NPI: 1962761122
Provider Name (Legal Business Name): AMY EPPSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S BURNS AVE
SPARTA IL
62286-1857
US

IV. Provider business mailing address

207 S BURNS AVE
SPARTA IL
62286-1857
US

V. Phone/Fax

Practice location:
  • Phone: 618-443-3084
  • Fax: 618-443-1339
Mailing address:
  • Phone: 618-443-1337
  • Fax: 618-443-1383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.142712
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.128125
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: