Healthcare Provider Details

I. General information

NPI: 1245562669
Provider Name (Legal Business Name): ANIK LIFE SCIENCES MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 02/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E GOLF RD SUITE 104
ARLINGTON HEIGHTS IL
60005-4078
US

IV. Provider business mailing address

209 LILAC ST
BOLINGBROOK IL
60490-2020
US

V. Phone/Fax

Practice location:
  • Phone: 847-593-6201
  • Fax:
Mailing address:
  • Phone: 630-581-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.122098
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036.122098
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036.122098
License Number StateIN

VIII. Authorized Official

Name: DR. NARAYANAPPA SATHISH BABU
Title or Position: DIRECTOR
Credential: M.D
Phone: 847-593-6201