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NPI Code Detail

MEDICARE: DR. AMAR LAL DAVE M.D.

MEDICARE: DR. AMAR LAL DAVE 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
1208000000XPediatrics PhysicianIL

General Provider Information

NPI Number : 1558369926
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMAR LAL DAVE M.D.
Provider Business Mailing Address
First Line : 1209 STARFIRE DR
Second Line : STE #1
City : OTTAWA
State : IL
Zip : 61350-1614
Country : US
Telephone Number : 815-434-2115
Fax Number : 815-434-2116
Provider Business Practice Location Address
First Line : 1209 STARFIRE DR
Second Line : STE #1
City : OTTAWA
State : IL
Zip : 61350-1614
Country : US
Telephone Number : 815-434-2115
Fax Number : 815-434-2116
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2005
Last Update Date : 01/04/2008

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