Provider Demographics
NPI:1255310157
Name:AN, HOWARD S (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:S
Last Name:AN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 WESTBROOK CORPORATE CTR
Mailing Address - Street 2:SUITE #240
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1611 W HARRISON ST
Practice Address - Street 2:# 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-243-4244
Practice Address - Fax:312-942-1517
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096491207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207073OtherMEDICARE PTAN LOCALITY 15
DA4902OtherRAILROAD MEDICARE PTAN
4571847OtherAETNA
P00095449OtherRAILROAD MEDICARE
IL1633878OtherBCBS
IL207067OtherMEDICARE PTAN LOCALITY 16
ILE94913Medicare UPIN
IL1633878OtherBCBS
P00095449OtherRAILROAD MEDICARE