Provider Demographics
NPI:1982733507
Name:AMIN, SANJAY J (MD)
Entity type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:J
Last Name:AMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 N COLUMBUS DR
Mailing Address - Street 2:SUITE 4108
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7810
Mailing Address - Country:US
Mailing Address - Phone:773-818-9850
Mailing Address - Fax:
Practice Address - Street 1:222 N COLUMBUS DR
Practice Address - Street 2:SUITE 4108
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7810
Practice Address - Country:US
Practice Address - Phone:773-818-9850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF85197Medicare UPIN