MEDICARE: DR. EBRAHIM AMANI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	36-95344	IL
2	207Q00000X	Family Medicine Physician	3695344	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01160490	OTHER	IL	MEDICARE RAIL ROAD PTAN (INDIVIDUAL)
3	920540	OTHER	IL	MEDICARE PTAN (GROUP)
4	920540035	OTHER	IL	MEDICARE PTAN (INDIVIDUAL)
5	CA4748	OTHER	IL	MEDICARE RAIL ROAD PTAN (GROUP)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386615904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EBRAHIM AMANI M.D.

Provider Business Mailing Address
First Line	:	1049 E WILSON ST
Second Line	:	SUITE 160B
City	:	BATAVIA
State	:	IL
Zip	:	60510-2474
Country	:	US
Telephone Number	:	630-232-2776
Fax Number	:

Provider Business Practice Location Address
First Line	:	1049 E WILSON ST
Second Line	:	SUITE 160B
City	:	BATAVIA
State	:	IL
Zip	:	60510-2474
Country	:	US
Telephone Number	:	630-232-2776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	12/13/2013

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Directions to “ DR. EBRAHIM AMANI M.D.” Practice Location

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