Provider Demographics
NPI:1215967765
Name:TAUB, AMY F (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:F
Last Name:TAUB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:275 PARKWAY DR STE 521
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-4344
Practice Address - Country:US
Practice Address - Phone:847-459-6400
Practice Address - Fax:847-459-4610
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.073151207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC40069Medicare UPIN
IL204639Medicare ID - Type Unspecified