Healthcare Provider Details

I. General information

NPI: 1114220712
Provider Name (Legal Business Name): AMRO AMER CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E GRAY ST
LOUISVILLE KY
40202-2012
US

IV. Provider business mailing address

13109 DOGWOOD FOREST CT
LOUISVILLE KY
40245-1995
US

V. Phone/Fax

Practice location:
  • Phone: 502-509-1046
  • Fax:
Mailing address:
  • Phone: 502-509-1046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: