Provider Demographics
NPI:1538513601
Name:BOZICH, AMANDA (DPM)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BOZICH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BIESTERFIELD RD STE 207
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3378
Mailing Address - Country:US
Mailing Address - Phone:847-228-6543
Mailing Address - Fax:847-577-3587
Practice Address - Street 1:800 BIESTERFIELD RD STE 207
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3378
Practice Address - Country:US
Practice Address - Phone:847-228-6543
Practice Address - Fax:847-577-3587
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005823213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist