Basic Information
Provider Information
NPI: 1619974532
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AMIN
FirstName: NEHA
MiddleName: N
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3428
Address2:  
City: SPRINGFIELD
State: IL
PostalCode: 627083428
CountryCode: US
TelephoneNumber: 2177577491
FaxNumber: 2177572021
Practice Location
Address1: 747 N RUTLEDGE ST
Address2: BAYLIS BUILDING, 2ND FLOOR
City: SPRINGFIELD
State: IL
PostalCode: 627026700
CountryCode: US
TelephoneNumber: 2177577932
FaxNumber: 2177577920
Other Information
ProviderEnumerationDate: 07/07/2005
LastUpdateDate: 07/09/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X ILY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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