Individual
DR. ANNA MICHELLE EDMISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
300 N MILWAUKEE AVE STE L, LAKE VILLA, IL 60046
(847) 356-0700
Mailing address
300 N MILWAUKEE AVE STE L, LAKE VILLA, IL 60046-8563
(847) 356-0700
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036.146283
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036.146283
ILLINOIS LICENSE
IL
Enumeration date
05/19/2014
Last updated
07/25/2018
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