Provider Demographics
NPI:1730303439
Name:AMUH, DONALD (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:AMUH
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 1:17200 CONSTANCE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-3625
Mailing Address - Country:US
Mailing Address - Phone:708-331-6383
Mailing Address - Fax:708-331-6425
Practice Address - Street 1:1701 W MONTEREY AVE
Practice Address - Street 2:SUITE#1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4257
Practice Address - Country:US
Practice Address - Phone:773-445-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RI0200X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL201163Medicare ID - Type Unspecified
ILG80569Medicare UPIN