Mushyam, Amitha

Mushyam, Amitha is an individual health care provider with primary practice located at 360 Station Dr , Crystal Lake IL 60014. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Mushyam, Amitha can be contacted via phone (815) 338-6600.

Contact Information

Primary practice address
360 Station Dr Crystal Lake IL 60014
Phone: (815) 338-6600
Fax: (815) 455-8044
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036120455 Illinois

Profile Details

NPI number 1972729283
LBN Legal business name Mushyam, Amitha
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 17th, 2007
Last updated Oct 19th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972729283 NPPES
Illinois MEDICAID 036120455-1
Illinois Other 036120455
Illinois MEDICAID 1972729283

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