Provider Demographics
NPI:1881669158
Name:WAHAB, AMIR JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:JOHN
Last Name:WAHAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:515 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-1401
Mailing Address - Country:US
Mailing Address - Phone:217-732-9681
Mailing Address - Fax:217-735-6373
Practice Address - Street 1:515 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-1401
Practice Address - Country:US
Practice Address - Phone:217-732-9681
Practice Address - Fax:217-735-6373
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G57900Medicare UPIN
ILL53031Medicare ID - Type Unspecified