Healthcare Provider Details

I. General information

NPI: 1841289873
Provider Name (Legal Business Name): LORI L. ANDERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S ARLINGTON HEIGHTS RD
ARLINGTON HEIGHTS IL
60005-1929
US

IV. Provider business mailing address

363 W NORTHWEST HWY CENTURY PLAZA
PALATINE IL
60067-2414
US

V. Phone/Fax

Practice location:
  • Phone: 847-221-4400
  • Fax: 847-221-4465
Mailing address:
  • Phone: 847-221-4600
  • Fax: 847-221-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number036-065423
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: