Provider Demographics
NPI:1578870846
Name:ANNE, VASANTHA L (MD)
Entity Type:Individual
Prefix:DR
First Name:VASANTHA
Middle Name:L
Last Name:ANNE
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 1:2901 N. KNOXVILLE AVE.
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603
Mailing Address - Country:US
Mailing Address - Phone:309-688-7010
Mailing Address - Fax:309-688-7044
Practice Address - Street 1:2901 N. KNOXVILLE AVE.
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603
Practice Address - Country:US
Practice Address - Phone:309-688-7010
Practice Address - Fax:309-688-7044
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123747207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology