MEDICARE: BASHIRAHMED M AMEJI 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	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1750566162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASHIRAHMED M AMEJI M.D.

Provider Business Mailing Address
First Line	:	3820 EAST MAIN STREET
Second Line	:	DANVILLE CORRECTIONAL CENTER MEDICAL DEPARTMENT
City	:	DANVILLE
State	:	IL
Zip	:	61834-5796
Country	:	US
Telephone Number	:	217-446-0441
Fax Number	:

Provider Business Practice Location Address
First Line	:	3820 EAST MAIN STREET
Second Line	:	DANVILLE CORRECTIONAL CENTER MEDICAL DEPARTMENT
City	:	DANVILLE
State	:	IL
Zip	:	61834-5796
Country	:	US
Telephone Number	:	217-446-0441
Fax Number	:

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

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	01/03/2008

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