Healthcare Provider Details

I. General information

NPI: 1609720085
Provider Name (Legal Business Name): KAMAL AMIROUCHE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 N WILLIAMSBURG COUNTY HWY
CADES SC
29518-3008
US

IV. Provider business mailing address

14367 CREEKWOOD DR
ORLAND PARK IL
60467-7106
US

V. Phone/Fax

Practice location:
  • Phone: 843-210-5000
  • Fax:
Mailing address:
  • Phone: 630-696-0958
  • Fax: 630-696-0958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209.031878
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: