# ANTHONY O AMIEWALAN MD, SC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ANTHONY O AMIEWALAN MD SC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053543215
- **Authorized official:** DR. ANTHONY O AMIEWALAN MD (DOCTOR)
- **Authorized official phone:** (217) 422-0560

## Contact information

- **Practice address:** 2965 N MAIN ST STE A, DECATUR, IL 62526-4397
- **Practice address phone:** (217) 422-0560
- **Practice address fax:** (217) 422-0872
- **Mailing address:** 2665 NORTH MAIN STREET, SUITE A, DECATUR, IL 62526-3803
- **Mailing address phone:** (217) 422-0560
- **Mailing address fax:** (217) 422-0872

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 173000000X | Legal Medicine | 036112019 | IL | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/20/2009
- **Last updated:** 03/27/2025