Provider Demographics
NPI:1194284174
Name:MACQUOID, AMANDA (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MACQUOID
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 1:1224 W VAN BUREN ST APT 716
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3365
Mailing Address - Country:US
Mailing Address - Phone:806-239-5558
Mailing Address - Fax:
Practice Address - Street 1:5668 E STATE ST STE 1000
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2443
Practice Address - Country:US
Practice Address - Phone:815-229-7580
Practice Address - Fax:815-229-7585
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125074404208600000X
IL0361712302086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery