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General NPI Number Information
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NPI Number | 1457367070
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Entity Type | Organization
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Legal Business Name | ANTHONY O AMIEWALAN MD, SC
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 2965 N MAIN ST STE A
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City | DECATUR
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State | IL
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Zip | 62526-4397
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Country | US
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Telephone | 217-422-0560
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Fax | 217-422-0872
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Provider Business Mailing Address
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Address Line | 2965 N MAIN ST STE A
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City | DECATUR
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State | IL
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Zip | 62526-4397
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Country | US
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Telephone | 217-422-0560
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Fax | 217-422-0872
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. GEORGIA M AMIEWALAN
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Credential |
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Telephone | 217-422-0560
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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 | 036112019
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 036112019
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License Number State | IL
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