Provider Demographics
NPI:1225231707
Name:ANNITA JOHN M.D. P.C.
Entity Type:Organization
Organization Name:ANNITA JOHN M.D. P.C.
Other - Org Name:HERITAGE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANNITA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-238-1616
Mailing Address - Street 1:10237 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1917
Mailing Address - Country:US
Mailing Address - Phone:773-238-1616
Mailing Address - Fax:773-238-2660
Practice Address - Street 1:10237 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1917
Practice Address - Country:US
Practice Address - Phone:773-238-1616
Practice Address - Fax:773-238-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0161873463OtherBCBS
IL335570Medicare ID - Type Unspecified