Provider Demographics
NPI:1376840041
Name:SAMALA, ANUVESHA (MD)
Entity Type:Individual
Prefix:
First Name:ANUVESHA
Middle Name:
Last Name:SAMALA
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 1:4235 CORAL BERRY PATH
Mailing Address - Street 2:APPARTMENT # 202
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-9321
Mailing Address - Country:US
Mailing Address - Phone:424-201-4721
Mailing Address - Fax:
Practice Address - Street 1:2723 SHERIDAN RD
Practice Address - Street 2:SUITE # C
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-2616
Practice Address - Country:US
Practice Address - Phone:847-360-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.129206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine