Provider Demographics
NPI:1255308334
Name:IVANENKO, ANNA (MD PHD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:IVANENKO
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3361
Mailing Address - Country:US
Mailing Address - Phone:847-981-3660
Mailing Address - Fax:847-956-5108
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:SUITE 510
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-981-3660
Practice Address - Fax:847-956-5108
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL361089932084P0800X
IL0361089932084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36108993Medicaid
IL1617373OtherBCBS OF IL
ILK53241Medicare PIN
ILH40177Medicare UPIN
ILK07637Medicare PIN
ILP00768158Medicare PIN