Individual
MALLIKARJUNA ANNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2233 W DIVISION ST, CHICAGO, IL 60622-3043
(312) 770-2000
Mailing address
PO BOX 3133, INDIANAPOLIS, IN 46206-3133
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
Primary
036044990
IL
207ZH0000X
Hematology (Pathology) Physician
036044990
IL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
036044990
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01634127
BCBS IL
IL
05
—
036044990
—
IL
Enumeration date
10/05/2006
Last updated
05/09/2012
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