Provider Demographics
NPI:1922767573
Name:ALAN TONY AMBERG PLLC
Entity Type:Organization
Organization Name:ALAN TONY AMBERG PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:AMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:312-804-1647
Mailing Address - Street 1:35 E WACKER DR STE 1764
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-2271
Mailing Address - Country:US
Mailing Address - Phone:312-229-0029
Mailing Address - Fax:844-905-1504
Practice Address - Street 1:35 E WACKER DR STE 1764
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-2271
Practice Address - Country:US
Practice Address - Phone:312-229-0029
Practice Address - Fax:844-905-1504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALAN ANTHONY AMBERG APRN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty