Individual
JACK C AMATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16687 SAINT CLAIR AVE, SUITE 203, EAST LIVERPOOL, OH 43920-9401
(330) 424-7221
(330) 424-3731
Mailing address
7880 LINCOLE PL, LISBON, OH 44432-8322
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
35036022
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000371276
ANTHEM BLUE SHIELD
OH
05
—
0298959
—
OH
Enumeration date
06/29/2006
Last updated
07/08/2007
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