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General NPI Number Information
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NPI Number | 1467444620
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Entity Type | Individual
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Provider Name | CHARLES ANTHONY AMENTA III M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 18161 MORRIS AVE SUITE 105
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City | HOMEWOOD
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State | IL
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Zip | 60430-2108
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Country | US
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Telephone | 708-799-5520
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Fax | 708-799-5358
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Provider Business Mailing Address
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Address Line | 18161 MORRIS AVE SUITE 105
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City | HOMEWOOD
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State | IL
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Zip | 60430-2108
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Country | US
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Telephone | 708-799-5520
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Fax | 708-799-5358
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 036075600
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036075600
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License Number State | IL
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