Provider Demographics
NPI:1205949484
Name:BIRN-FORYS, ANNA (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:BIRN-FORYS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 W GUNNISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3215
Mailing Address - Country:US
Mailing Address - Phone:773-545-2525
Mailing Address - Fax:773-205-5700
Practice Address - Street 1:5605 W GUNNISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3215
Practice Address - Country:US
Practice Address - Phone:773-545-2525
Practice Address - Fax:773-205-5700
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036074208Medicaid
ILL70042Medicare PIN
IL036074208Medicaid