Provider Demographics
NPI:1265432322
Name:ANANDAPPA, EUGENE C (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:C
Last Name:ANANDAPPA
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 1:225 E CHICAGO AVE # 9
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-4500
Mailing Address - Fax:312-227-9785
Practice Address - Street 1:225 E CHICAGO AVE # 9
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-4500
Practice Address - Fax:312-227-9785
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360464212085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046421Medicaid
IL021622158OtherCMMG BLUE SHIELD NUMBER
ILL86892Medicare ID - Type UnspecifiedDU PAGE CNTY MDCR NUMBER
IL036046421Medicaid
ILH35291Medicare UPIN
IL708070Medicare ID - Type UnspecifiedCMMG GROUP MDCR NUMBER
IL702730Medicare ID - Type UnspecifiedCMMG MEDICARE GROUP NO.