Provider Demographics
NPI:1801816277
Name:WEST, ANN LUISE (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:LUISE
Last Name:WEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1310 N MAIN ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-1394
Mailing Address - Country:US
Mailing Address - Phone:815-786-1967
Mailing Address - Fax:815-786-1806
Practice Address - Street 1:1310 N MAIN ST
Practice Address - Street 2:SUITE 209
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-1394
Practice Address - Country:US
Practice Address - Phone:815-786-1967
Practice Address - Fax:815-786-1806
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036072751207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072751Medicaid
ILC39058Medicare UPIN
IL036072751Medicaid