Healthcare Provider Details

I. General information

NPI: 1689242794
Provider Name (Legal Business Name): ANNA SCALZO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W NORTH AVE
CHICAGO IL
60610-1174
US

IV. Provider business mailing address

711 W NORTH AVE
CHICAGO IL
60610-1174
US

V. Phone/Fax

Practice location:
  • Phone: 312-337-1982
  • Fax:
Mailing address:
  • Phone: 312-337-1982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036170724
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: