MEDICARE: ANNA BUNPLOOG-LANE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036-110715	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	01635798	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1356425755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA BUNPLOOG-LANE M.D.

Provider Business Mailing Address
First Line	:	3120 EMERSON ST
Second Line	:
City	:	FRANKLIN PARK
State	:	IL
Zip	:	60131-2621
Country	:	US
Telephone Number	:	847-671-0380
Fax Number	:

Provider Business Practice Location Address
First Line	:	6301 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2009
Country	:	US
Telephone Number	:	773-761-0300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	04/22/2025

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Directions to “ ANNA BUNPLOOG-LANE M.D.” Practice Location

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