Organization
ANTHONY O AMIEWALAN MD, SC
Active
Parent organization
VIVIAN WOMENS CENTER, INC
Other names
ANTHONY AMIEWALAN MD SC, ANTHONY O AMIEWALAN, VIVIAN WOMEN CENTER , INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
VIVIAN WOMENS CENTER, INC
Authorized official
MRS. GEORGIA M AMIEWALAN (BUSINESS MANAGER)
(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
2965 N MAIN ST STE A, DECATUR, IL 62526-4397
(217) 422-0560
(217) 422-0872
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
036112019
IL
207VG0400X
Gynecology Physician
—
—
207VX0000X
Obstetrics Physician
Primary
036112019
IL
261Q00000X
Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112019
—
IL
Enumeration date
08/01/2006
Last updated
03/27/2025
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