Healthcare Provider Details

I. General information

NPI: 1023830726
Provider Name (Legal Business Name): ANJALI GEORGE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10604 SOUTHWEST HWY STE 109
CHICAGO RIDGE IL
60415-2717
US

IV. Provider business mailing address

62647 COLLECTIONS CENTER DR
CHICAGO IL
60693-0626
US

V. Phone/Fax

Practice location:
  • Phone: 708-422-3242
  • Fax: 708-422-3243
Mailing address:
  • Phone: 708-645-5265
  • Fax: 430-205-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085012046
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: