ANTHONY O AMIEWALAN MD, SC (NPI# 1053543215) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053543215 |
| Entity Type | Organization |
| Organization Name | ANTHONY O AMIEWALAN MD, SC |
| Practice Address |
1750 E Lake Shore Dr Suite 320 Decatur IL 62521-3803 |
| Mailing Address |
1750 E Lake Shore Dr Suite320 Decatur IL 62521-3803 |
| Practice Telephone | 2174220560 |
| Practice Fax Number | 2174220872 |
| Mailing Telephone | 2174220560 |
| Mailing Fax Number | 2174220872 |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2009-08-20 |
| Authorized Official Name | DR. ANTHONY O AMIEWALAN (OWNER) |
| Authorized Official Telephone | 2174220560 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 173000000X | Legal Medicine | 036112019 | IL | Other Service Providers |
| Street Address |
1750 E LAKE SHORE DR SUITE 320 |
| City | DECATUR |
| State | IL |
| Zip Code | 62521-3803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285621516 | Jon Fredrick Petersen | Family Medicine | 1750 E Lake Shore Dr, Decatur, IL 62521-3803 | 2005-10-03 |
| 1265947451 | Antoniannette Pate | Nurse Practitioner | 1750 E Lake Shore Dr, Decatur, IL 62521-3803 | 2017-12-10 |
| 1578093225 | Jason Blanchetti | Nurse Practitioner | 1750 E Lake Shore Dr, Decatur, IL 62521-3803 | 2017-06-15 |
| 1992182331 | Alyson Webb | Nurse Practitioner | 1750 E Lake Shore Dr, Ste 310, Decatur, IL 62521-3803 | 2015-05-06 |
| 1932527017 | Adills Moosa | Preventive Medicine | 1750 E Lake Shore Dr, Decatur, IL 62521-3803 | 2014-04-04 |
| 1841579026 | Justin William Kierbs | Nurse Practitioner | 1750 E Lake Shore Dr, Suite 200, Decatur, IL 62521-3803 | 2011-08-05 |
| 1194012260 | Nikesh Lath | Surgery | 1750 E Lake Shore Dr, Decatur, IL 62521-3803 | 2011-07-08 |
| 1922319839 | Chinelo C Echeazu | Obstetrics & Gynecology | 1750 E Lake Shore Dr, Suite 110, Decatur, IL 62521 | 2010-06-24 |
| 1215267596 | Vikram S Kotwal | Internal Medicine | 1750 E Lake Shore Dr, Suite 310, Decatur, IL 62521-3803 | 2010-01-08 |
| 1396073813 | Mohammed A. Rahman | Neurological Surgery | 1750 E Lake Shore Dr, 110, Decatur, IL 62521-3803 | 2009-11-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053927988 | Caleb David Braasch | Pharmacist | 1818 South Airport Rd, Decatur, IL 62521 | 2020-09-16 |
| 1295390490 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | Crossing Recovery Center, 495 East Central Ave, Decatur, IL 62521 | 2019-05-03 |
| 1396300638 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 E Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1679138911 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 East Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1154848034 | Zack Shaw | Physical Therapist | 4855-57 East 36, Decatur, IL 62521 | 2017-08-23 |
| 1790032852 | Prashant Morolia | Family Medicine | 4775 E Maryland St, Decatur, IL 62521 | 2012-08-08 |
| 1003188913 | Evergreen Place Decatur, LLC | Assisted Living Facility | 4825 E Evergreen Court, Decatur, IL 62521 | 2012-02-08 |
| 1104133099 | Suzette Marie Shafer | Occupational Therapy Assistant | 1790 S. Fairview Ave., Decatur, IL 62521 | 2010-09-13 |
| 1467784090 | Community Health Improvement Center | Clinic/Center | 1221 East Condit Street, Decatur, IL 62521 | 2010-02-08 |
| 1982839056 | Kelly Clark Dds PC | Dentist | 3737 Us Rt 36 E, Decatur, IL 62521 | 2009-05-19 |
| Find all providers in zip 62521 | ||||
| Taxonomy Code | 173000000X |
| Grouping | Other Service Providers |
| Classification | Legal Medicine |
| The specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical examinations at crime scenes, performance of autopsies, giving of expert medical testimony in judicial proceedings, medical treatment of inmates of penal institutions, the practice of trauma medicine in law enforcement settings, and other clinical practice and medical science applications in the fields of law, law enforcement, and corrections. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
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| 1548672512 | Bj Med Clinic LLC | Legal Medicine | 1867 Lawrenceville Hwy, Decatur, GA 30033-5729 | 2014-05-27 |
| 1265844468 | Bj Med Clinic LLC | Legal Medicine | 1867 Lawrenceville Hwy, Decatur, GA 30033-5729 | 2014-05-22 |
| 1356591937 | Ob/gyn Women Specialists of Georgia, PC | Legal Medicine | 3951 Snapfinger Pkwy, Suite 350, Decatur, GA 30035-3202 | 2008-09-19 |
| 1538343439 | Total Health Medical Center Corporation | Legal Medicine | 4153 Flat Shoals Pkwy, Bldg A, Ste 104, Decatur, GA 30034-1680 | 2007-12-27 |
| 1942425517 | Progressive Family Health | Legal Medicine | 1110 Arbor Dr, Suite D, Decatur, IL 62526-9285 | 2007-04-17 |
| 1558400150 | Macon County Medical Associates, P.C. | Legal Medicine | 2981 N Main St, Decatur, IL 62526-3259 | 2007-02-06 |
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| 1063962066 | Champaign County Coroner | Legal Medicine | 202 Art Bartell Rd, Urbana, IL 61802-2889 | 2016-10-13 |
| 1013356278 | Malgorzata K. Barnas | Legal Medicine | 4713 N New England Ave, Harwood Heights, IL 60706-3911 | 2013-06-20 |
| 1487923330 | Albert George Mitsos | Legal Medicine | 5675 Port Clinton Rd, Long Grove, IL 60047-5059 | 2011-12-22 |
| 1467737882 | North Shore Pediatrics | Legal Medicine | 9933 Lawler Ave Ste 305, Skokie, IL 60077-3713 | 2011-10-17 |
| 1992934673 | Remegio M Vilbar Mdsc | Legal Medicine | 1431 N Western Ave Ste 202, Chicago, IL 60622-7712 | 2009-07-02 |
| 1467669200 | Chicago North Medical Partnership | Legal Medicine | 5308 N Broadway St, Chicago, IL 60640-2312 | 2007-05-17 |
| 1730306358 | Shanmugavelayutham Ramasamy | Legal Medicine | 7933 Oakview Ln, Woodridge, IL 60517-3742 | 2007-04-18 |
| 1023231289 | Willowbrook Medical Center Ltd. | Legal Medicine | 535 Plainfield Road, Suite C, Willowbrook, IL 60527 | 2007-04-10 |
| 1508983651 | Ann M Bova | Legal Medicine | 907 Clock Tower Dr, Springfield, IL 62704-6023 | 2007-03-23 |
| 1669518163 | Ghulam J. Dhar | Legal Medicine | 404 Sherwood Rd, La Grange Park, IL 60526-1968 | 2007-01-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.