Provider Demographics
NPI:1477933042
Name:RODENBOUGH, ANNA LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LOUISE
Last Name:RODENBOUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 HARVESTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5965
Mailing Address - Country:US
Mailing Address - Phone:773-702-7553
Mailing Address - Fax:773-834-0748
Practice Address - Street 1:5721 S MARYLAND AVE
Practice Address - Street 2:MC 8016, K155
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:773-702-7553
Practice Address - Fax:773-834-0748
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125066796208000000X
IL036145849207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics