Provider Demographics
NPI:1962636381
Name:ANANTH, ANUPAMA LAKSHMI (DO)
Entity Type:Individual
Prefix:
First Name:ANUPAMA
Middle Name:LAKSHMI
Last Name:ANANTH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4901 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1554
Mailing Address - Country:US
Mailing Address - Phone:312-609-0300
Mailing Address - Fax:312-842-5897
Practice Address - Street 1:2555 S. MARTIN LUTHER KING, JR. DRIVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-5500
Practice Address - Country:US
Practice Address - Phone:312-609-0300
Practice Address - Fax:312-842-5897
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.129255207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine