Individual
AMANDA GOSTIGIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
800 E CARPENTER STREET BOX 43, SPRINGFIELD, IL 62769-4968
(217) 814-5178
(217) 757-6458
Mailing address
800 E CARPENTER STREET BOX 43, SPRINGFIELD, IL 62769-0001
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
125081875
IL
363A00000X
Physician Assistant
—
FL
Other
Enumeration date
08/24/2016
Last updated
06/27/2024
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