Individual
AMY WEATHERWAX VANDENBROOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
145 OGDEN AVE, DOWNERS GROVE, IL 60515-2323
(630) 971-2020
(630) 964-2211
Mailing address
6233 CERMAK RD, BERWYN, IL 60402-2317
(708) 749-2020
(708) 749-2069
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036-104595
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001622078
BLUS CROSS BLUE SHEILD
IL
05
—
036104595
—
IL
Enumeration date
10/18/2006
Last updated
10/13/2011
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