Provider Demographics
NPI:1871544932
Name:BAMZAI, AMEETA K (MD)
Entity type:Individual
Prefix:
First Name:AMEETA
Middle Name:K
Last Name:BAMZAI
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 1:1831 BAYSCOTT CIRCLE
Mailing Address - Street 2:STE 109 NAPERVILLE CHILDRENS CLINIC
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540
Mailing Address - Country:US
Mailing Address - Phone:630-961-1341
Mailing Address - Fax:630-961-1782
Practice Address - Street 1:1831 BAYSCOTT CIRCLE
Practice Address - Street 2:STE 109 NAPERVILLE CHILDRENS CLINIC
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540
Practice Address - Country:US
Practice Address - Phone:630-961-1341
Practice Address - Fax:630-961-1782
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360542342080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054234Medicaid
IL686040Medicare ID - Type Unspecified
IL036054234Medicaid