Provider Demographics
NPI:1750566162
Name:AMEJI, BASHIRAHMED M (MD)
Entity type:Individual
Prefix:
First Name:BASHIRAHMED
Middle Name:M
Last Name:AMEJI
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 1:3820 EAST MAIN STREET
Mailing Address - Street 2:DANVILLE CORRECTIONAL CENTER MEDICAL DEPARTMENT
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-5796
Mailing Address - Country:US
Mailing Address - Phone:217-446-0441
Mailing Address - Fax:
Practice Address - Street 1:3820 EAST MAIN STREET
Practice Address - Street 2:DANVILLE CORRECTIONAL CENTER MEDICAL DEPARTMENT
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61834-5796
Practice Address - Country:US
Practice Address - Phone:217-446-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine