Basic Information
| Provider Information | |||||||||
| NPI: | 1588190821 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANNE | ||||||||
| FirstName: | ASHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7447 W TALCOTT AVE | ||||||||
| Address2: | RESURRECTION FAMILY MEDICINE STE. 182 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606313745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739907648 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7447 W TALCOTT AVE | ||||||||
| Address2: | RESURRECTION FAMILY MEDICINE STE. 182 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606313745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739907648 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2017 | ||||||||
| LastUpdateDate: | 05/05/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | IL | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.