Individual
ANNE E NIEDENTHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1625 N SHERIDAN RD, UNIT 4, WILMETTE, IL 60091
(847) 853-8100
(847) 853-8116
Mailing address
1625 N SHERIDAN RD, UNIT 4, WILMETTE, IL 60091
(847) 853-8100
(847) 853-8116
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036070530
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001606168
BLUE CROSS BLUE SHIELD
IL
01
—
4043722
AETNA
IL
01
—
6673072005
CIGNA
IL
Enumeration date
08/21/2006
Last updated
07/11/2008
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