Basic Information
| Provider Information | |||||||||
| NPI: | 1699943720 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AMIN | ||||||||
| FirstName: | MIRAL | ||||||||
| MiddleName: | SAPAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2520 ELISHA AVE | ||||||||
| Address2: | |||||||||
| City: | ZION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478724561 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2361 PAYSPHERE CIR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477464538 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2008 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4301085460 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 036.133767 | IL | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.