Individual
ANNIE JOHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3434 W PETERSON AVE, 1A, CHICAGO, IL 60659-3319
(773) 583-5803
(773) 248-2348
Mailing address
P.O. BOX 2248, CAROL STREAM, IL 60132-0001
(847) 676-0091
(773) 248-2348
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
036068169
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036068169
—
IL
Enumeration date
12/14/2005
Last updated
06/17/2014
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