Provider Demographics
NPI:1104817642
Name:AMIN, NILA J (MD)
Entity type:Individual
Prefix:
First Name:NILA
Middle Name:J
Last Name:AMIN
Suffix:
Gender:F
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:PO BOX 245
Mailing Address - Street 2:725 N SPENCER STREET
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-0245
Mailing Address - Country:US
Mailing Address - Phone:765-932-5996
Mailing Address - Fax:765-932-4996
Practice Address - Street 1:725 N SPENCER ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-1558
Practice Address - Country:US
Practice Address - Phone:765-932-5996
Practice Address - Fax:765-932-4996
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030546A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C25001Medicare UPIN
IN710500Medicare ID - Type Unspecified