Provider Demographics
NPI:1699154120
Name:DAUTEN, AMANDA (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DAUTEN
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 1:1285 HARTREY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1056
Mailing Address - Country:US
Mailing Address - Phone:847-666-3493
Mailing Address - Fax:847-868-8978
Practice Address - Street 1:1285 HARTREY AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1056
Practice Address - Country:US
Practice Address - Phone:847-666-3493
Practice Address - Fax:847-868-8978
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036154503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine