Provider Demographics
NPI:1952581373
Name:GAMINO, AMIE J (MD)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:J
Last Name:GAMINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMIE
Other - Middle Name:J
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 054
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-942-6744
Mailing Address - Fax:312-942-3131
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 054
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-6744
Practice Address - Fax:312-942-3131
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-118579207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine