Provider Demographics
NPI:1285631838
Name:SAGAN-BLAUSIUS, ANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:SAGAN-BLAUSIUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 S PULASKI ROAD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632
Mailing Address - Country:US
Mailing Address - Phone:773-585-2410
Mailing Address - Fax:773-284-0913
Practice Address - Street 1:4321 S PULASKI ROAD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632
Practice Address - Country:US
Practice Address - Phone:773-585-2410
Practice Address - Fax:773-284-0913
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2021-03-29
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
IL036-101434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL41851OtherMALPRACTICE IN
IL036101434Medicaid
IL036-101434OtherIL STATE
IL14D0713711OtherCLIA
ILBS-6689890OtherBNDD
IL14D0713711OtherCLIA
IL41851OtherMALPRACTICE IN