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General NPI Number Information
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NPI Number | 1720523731
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Entity Type | Organization
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Legal Business Name | AMAR L DAVE
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Dates
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Enumeration Date | 12/29/2016
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Last Update Date | 12/29/2016
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Provider Practice Location Address
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Address Line | 1209 STARFIRE DR SUITE 1
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City | OTTAWA
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State | IL
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Zip | 61350-1614
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Country | US
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Telephone | 815-434-2115
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 STARFIRE DR SUITE 1
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City | OTTAWA
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State | IL
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Zip | 61350-1614
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Country | US
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Telephone | 815-434-2115
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Fax |
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Authorized Official
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Title or Position | MD OWNER
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Name | AMAR LAL DAVE
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Credential | MD
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Telephone | 815-434-2115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036057338
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License Number State | IL
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