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General NPI Number Information
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NPI Number | 1669486668
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Entity Type | Individual
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Provider Name | ANTHONY ORIA AMIEWALAN I MD FACOG
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 1750 EAST LAKE SHORE DR SUITE 320
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City | DECATUR
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State | IL
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Zip | 62521
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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 A2969N
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City | DECATUR
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State | IL
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Zip | 62526-4392
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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 |
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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 | 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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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036112019
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License Number State | IL
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