Provider Demographics
NPI:1629124243
Name:PONNAPPAN, ANAND (MD)
Entity Type:Individual
Prefix:DR
First Name:ANAND
Middle Name:
Last Name:PONNAPPAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 S. OAK PARK AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3420
Mailing Address - Country:US
Mailing Address - Phone:708-749-3070
Mailing Address - Fax:708-749-3410
Practice Address - Street 1:3340 S. OAK PARK AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3420
Practice Address - Country:US
Practice Address - Phone:708-749-3070
Practice Address - Fax:708-749-3410
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123972207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology