Provider Demographics
NPI:1558424903
Name:N J AMIN
Entity Type:Organization
Organization Name:N J AMIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:NARENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-389-0575
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-0639
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:2590 W WALTER ZIMNY DR
Practice Address - Street 2:
Practice Address - City:POSEN
Practice Address - State:IL
Practice Address - Zip Code:60469-1247
Practice Address - Country:US
Practice Address - Phone:708-389-0575
Practice Address - Fax:708-389-6527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21608840OtherBCBSIL GROUP #
IL21608840OtherBCBSIL GROUP #
ILK22412Medicare PIN
IL212537Medicare PIN
ILDE0910Medicare PIN