Provider Demographics
NPI:1184673147
Name:AMANULLAH, JAMALUDDIN F (MD)
Entity Type:Individual
Prefix:
First Name:JAMALUDDIN
Middle Name:F
Last Name:AMANULLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 BROADWAY ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-3905
Mailing Address - Country:US
Mailing Address - Phone:314-971-5717
Mailing Address - Fax:309-620-8751
Practice Address - Street 1:2401 BROADWAY ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3905
Practice Address - Country:US
Practice Address - Phone:314-971-5717
Practice Address - Fax:309-620-8751
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084268174400000X
IL036127585174400000X
MO2009011799174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
107048Medicare UPIN