Provider Demographics
NPI:1780604900
Name:AMIN, ANIL J (MD)
Entity type:Individual
Prefix:
First Name:ANIL
Middle Name:J
Last Name:AMIN
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 1:5666 EAST STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2472
Mailing Address - Country:US
Mailing Address - Phone:815-226-2000
Mailing Address - Fax:815-227-2880
Practice Address - Street 1:5666 EAST STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2472
Practice Address - Country:US
Practice Address - Phone:815-226-2000
Practice Address - Fax:815-227-2880
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113617208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK17763Medicare ID - Type Unspecified
I 29852Medicare UPIN