Individual
DR. CHARLES ANTHONY AMENTA III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
18161 MORRIS AVE, SUITE 105, HOMEWOOD, IL 60430-2108
(708) 799-5520
(708) 799-5358
Mailing address
18161 MORRIS AVE, SUITE 105, HOMEWOOD, IL 60430-2108
(708) 799-5520
(708) 799-5358
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036075600
IL
207Y00000X
Otolaryngology Physician
Primary
036075600
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01606798
BLUE CROSS BLUE SHIELD
IL
05
—
036075600
—
IL
01
—
040010012
RAILROAD MEDICARE
GA
01
—
05055067
AETNA
TX
Enumeration date
08/15/2005
Last updated
02/20/2025
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