Provider Demographics
NPI:1811301823
Name:PRICE, AMBER NICOLE (MD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:PRICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:NICOLE
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1430 W. FILLMORE ST. #1E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607
Mailing Address - Country:US
Mailing Address - Phone:312-869-9556
Mailing Address - Fax:312-273-1665
Practice Address - Street 1:1430 W. FILLMORE ST. #1E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607
Practice Address - Country:US
Practice Address - Phone:312-869-9556
Practice Address - Fax:312-273-1665
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.144763208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics