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Organization
ANTHONY O AMIEWALAN MD, SC
Active
Organization
ANTHONY O AMIEWALAN MD, SC
Active
Other names
ANTHONY O AMIEWALAN MD SC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY O AMIEWALAN MD (DOCTOR)
(217) 422-0560
Entity
Organization
Contact information
Practice address
2965 N MAIN ST STE A, DECATUR, IL 62526-4397
(217) 422-0560
(217) 422-0872
Mailing address
2665 NORTH MAIN STREET, SUITE A, DECATUR, IL 62526-3803
(217) 422-0560
(217) 422-0872
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
036112019
IL
261Q00000X
Clinic/Center
—
NULL
261QH0100X
Health Service Clinic/Center
—
NULL
Other
Enumeration date
08/20/2009
Last updated
03/27/2025
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