Provider Demographics
NPI:1588179360
Name:CHRISANTHA E ANANDAPPA MD
Entity Type:Organization
Organization Name:CHRISANTHA E ANANDAPPA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISANTHA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANANDAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-557-1930
Mailing Address - Street 1:702 ASBURY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2135
Mailing Address - Country:US
Mailing Address - Phone:708-557-1930
Mailing Address - Fax:
Practice Address - Street 1:2500 W BRADLEY PL STE 100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4716
Practice Address - Country:US
Practice Address - Phone:773-649-0759
Practice Address - Fax:224-205-3757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.132734261QM0850X
MI4301092315261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health