Individual
DR. EBRAHIM AMANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1049 E WILSON ST, SUITE 160B, BATAVIA, IL 60510-2474
(630) 232-2776
Mailing address
1049 E WILSON ST, SUITE 160B, BATAVIA, IL 60510-2474
(630) 232-2776
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3695344
IL
208D00000X
General Practice Physician
36-95344
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036095344
—
IL
01
—
920540
MEDICARE PTAN (GROUP)
IL
01
—
920540035
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
CA4748
MEDICARE RAIL ROAD PTAN (GROUP)
IL
01
—
P01160490
MEDICARE RAIL ROAD PTAN (INDIVIDUAL)
IL
Enumeration date
01/31/2006
Last updated
12/13/2013
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