Healthcare Provider Details

I. General information

NPI: 1104817642
Provider Name (Legal Business Name): NILA J AMIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N SPENCER ST
RUSHVILLE IN
46173-1558
US

IV. Provider business mailing address

PO BOX 245 725 N SPENCER STREET
RUSHVILLE IN
46173-0245
US

V. Phone/Fax

Practice location:
  • Phone: 765-932-5996
  • Fax: 765-932-4996
Mailing address:
  • Phone: 765-932-5996
  • Fax: 765-932-4996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01030546A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: