MEDICARE: N J AMIN

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	207Q00000X	Family Medicine Physician	036058553	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21608840	OTHER	IL	BCBSIL GROUP #

General Provider Information

NPI Number	:	1558424903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	N J AMIN

Provider Business Mailing Address
First Line	:	PO BOX 639
Second Line	:
City	:	MATTESON
State	:	IL
Zip	:	60443-0639
Country	:	US
Telephone Number	:	708-747-5850
Fax Number	:	708-747-9991

Provider Business Practice Location Address
First Line	:	2590 W WALTER ZIMNY DR
Second Line	:
City	:	POSEN
State	:	IL
Zip	:	60469-1247
Country	:	US
Telephone Number	:	708-389-0575
Fax Number	:	708-389-6527

Authorized Official
Title or Position	:	M.D.
Name	:	NARENDRA AMIN
Credential	:	M.D.
Telephone Number	:	708-389-0575

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	11/25/2009

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Directions to “N J AMIN ” Practice Location

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