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General NPI Number Information
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NPI Number | 1689994014
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Entity Type | Individual
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Provider Name | AMANDA M BRAMHAM MD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 1029 E 130TH ST
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City | CHICAGO
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State | IL
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Zip | 60628-6908
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Country | US
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Telephone | 773-995-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 HEALTH CENTER DR STE 201
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City | MATTOON
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State | IL
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Zip | 61938-4693
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Country | US
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Telephone | 217-238-6055
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 101592
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 83732-20
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-133693
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License Number State | IL
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