| Anthony O Amiewalan MD SC | |
|
2965 N Main St Ste A Decatur IL 62526-4397 | |
| (217) 422-0560 | |
| (217) 422-0872 |
| Full Name | Anthony O Amiewalan MD SC |
|---|---|
| Speciality | Legal Medicine |
| Location | 2965 N Main St Ste A, Decatur, Illinois |
| Authorized Official Name and Position | Anthony O Amiewalan (DOCTOR) |
| Authorized Official Contact | 2174220560 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Anthony O Amiewalan MD SC 2665 North Main Street Suite A Decatur IL 62526-3803 Ph: (217) 422-0560 | Anthony O Amiewalan MD SC 2965 N Main St Ste A Decatur IL 62526-4397 Ph: (217) 422-0560 |
| NPI Number | 1053543215 |
|---|---|
| Provider Enumeration Date | 08/20/2009 |
| Last Update Date | 03/27/2025 |
| Certification Date | 03/24/2025 |
| Medicare PECOS PAC ID | 7517003098 |
|---|---|
| Medicare Enrollment ID | O20091014000462 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053543215 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Secondary |
| 261QH0100X | Clinic/center - Health Service | (NU) | Secondary |
| 173000000X | Legal Medicine | 036112019 (Illinois) | Primary |
| Provider Name | Anthony O Amiewalan |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1669486668 PECOS PAC ID: 1658330832 Enrollment ID: I20041005000034 |
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