Provider Demographics
NPI:1750495321
Name:TENNENBAUM AND ANSTADT, LTD
Entity Type:Organization
Organization Name:TENNENBAUM AND ANSTADT, LTD
Other - Org Name:GOTTLIEB EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-450-4510
Mailing Address - Street 1:675 W NORTH AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1634
Mailing Address - Country:US
Mailing Address - Phone:708-450-4510
Mailing Address - Fax:708-450-9361
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-450-4510
Practice Address - Fax:708-450-9361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01608499OtherBLUE CROSS BLUE SHIELD
ILCD7287OtherRR MEDICARE
IL01608499OtherBLUE CROSS BLUE SHIELD
IL=========Medicaid