Provider Demographics
NPI:1336378819
Name:MCILWAIN, AMBER HOPE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:HOPE
Last Name:MCILWAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:4540 SHEPHERD SQ
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-3325
Practice Address - Country:US
Practice Address - Phone:228-255-8216
Practice Address - Fax:228-255-8219
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT68571207Q00000X
MS21215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine