Provider Demographics
NPI:1184665424
Name:AMIN, HETAL S (MD)
Entity Type:Individual
Prefix:DR
First Name:HETAL
Middle Name:S
Last Name:AMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:725 SCHOOL ST STE A
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1207
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-4363
Practice Address - Street 1:27240 W SAXONY DR STE 203
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-1417
Practice Address - Country:US
Practice Address - Phone:815-705-1300
Practice Address - Fax:815-705-1301
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111401207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00297321OtherRAIL ROAD MEDICARE
IL2215242OtherBCBS
I45961Medicare UPIN
ILK29594Medicare PIN
AM4173599Medicare PIN