MEDICARE: DR. CHARLES W AMPADU MD

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	207R00000X	Internal Medicine Physician	036083270	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1962545269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES W AMPADU MD

Provider Business Mailing Address
First Line	:	15 PARK PL
Second Line	:
City	:	SWANSEA
State	:	IL
Zip	:	62226-2918
Country	:	US
Telephone Number	:	618-257-0780
Fax Number	:	618-257-0715

Provider Business Practice Location Address
First Line	:	15 PARK PL
Second Line	:
City	:	SWANSEA
State	:	IL
Zip	:	62226-2918
Country	:	US
Telephone Number	:	618-257-0780
Fax Number	:	618-257-0715

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	09/06/2021

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Directions to “ DR. CHARLES W AMPADU MD” Practice Location

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