Provider Demographics
NPI:1225013238
Name:LAMBA, ANIL KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:KUMAR
Last Name:LAMBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:35318 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60678-0353
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:
Practice Address - Street 1:3700 W 203RD ST STE 201
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1182
Practice Address - Country:US
Practice Address - Phone:708-679-2120
Practice Address - Fax:708-503-3230
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053897208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053897Medicaid
ILF400292401OtherSPECIALTY PHYSICIANS OF ILLINOIS, LLC ILLINOIS PTAN
ILF400292401OtherSPECIALTY PHYSICIANS OF ILLINOIS, LLC ILLINOIS PTAN
ILD14816Medicare UPIN