Provider Demographics
NPI:1578541876
Name:ANDERSON, LYNN MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MICHELLE
Last Name:ANDERSON
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
Mailing Address - Street 2:STE 463
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631
Mailing Address - Country:US
Mailing Address - Phone:773-763-8400
Mailing Address - Fax:773-774-8085
Practice Address - Street 1:7447 W TALCOTT
Practice Address - Street 2:STE 463
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631
Practice Address - Country:US
Practice Address - Phone:773-763-8400
Practice Address - Fax:773-774-8085
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA8346808OtherDEA
H91623Medicare UPIN
ILX00215Medicare ID - Type Unspecified