Individual
EDEM S AGAMAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
315 W CARPENTER ST, 1ST FLOOR, CLINIC B, SPRINGFIELD, IL 62702-4901
(217) 545-8000
(217) 545-1141
Mailing address
315 W CARPENTER ST, PO BOX 19678, SPRINGFIELD, IL 62702-4901
(217) 545-8000
(217) 545-1141
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
036085000
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036085000
—
IL
01
—
272742
HEALTHLINK
IL
01
—
8415062
BLUE CROSS BLUE SHIELD
IL
01
—
900001174
RAILROAD MEDICARE
IL
Enumeration date
06/02/2006
Last updated
10/16/2020
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