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General NPI Number Information
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NPI Number | 1104137702
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Entity Type | Individual
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Provider Name | AMANDA TOWER MD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 3001 GREEN BAY RD
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City | NORTH CHICAGO
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State | IL
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Zip | 60064-3048
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Country | US
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Telephone | 224-610-7605
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Fax |
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Provider Business Mailing Address
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Address Line | 4832 N CLARK ST APT 103
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City | CHICAGO
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State | IL
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Zip | 60640-4731
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Country | US
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Telephone | 860-304-4756
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 49931
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License Number State | AZ
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