Provider Demographics
NPI:1558369926
Name:DAVE, AMAR LAL (MD)
Entity Type:Individual
Prefix:DR
First Name:AMAR
Middle Name:LAL
Last Name:DAVE
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 1:1209 STARFIRE DR
Mailing Address - Street 2:STE #1
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-1614
Mailing Address - Country:US
Mailing Address - Phone:815-434-2115
Mailing Address - Fax:815-434-2116
Practice Address - Street 1:1209 STARFIRE DR
Practice Address - Street 2:STE #1
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-1614
Practice Address - Country:US
Practice Address - Phone:815-434-2115
Practice Address - Fax:815-434-2116
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD16548Medicare UPIN