Provider Demographics
NPI:1497733828
Name:GOPANIUK-FOLGA, ANNA BEATA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:BEATA
Last Name:GOPANIUK-FOLGA
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 1:7447 W TALCOTT AVE STE 425
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3704
Mailing Address - Country:US
Mailing Address - Phone:773-763-8400
Mailing Address - Fax:773-774-8085
Practice Address - Street 1:7447 W TALCOTT AVE STE 425
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3704
Practice Address - Country:US
Practice Address - Phone:773-763-8400
Practice Address - Fax:773-774-8085
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086848207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BG4066367OtherDEA
G24148Medicare UPIN
ILL93393Medicare ID - Type Unspecified