Individual
AMY S WASCHULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
505 E GRANT ST, SUITE 110, MACOMB, IL 61455-3352
(309) 833-1733
(309) 836-2369
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036112128
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112128
—
IL
Enumeration date
10/04/2006
Last updated
05/19/2020
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