Healthcare Provider Details

I. General information

NPI: 1649342783
Provider Name (Legal Business Name): ENOCH SESHIE ANAGLATE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S CALIFORNIA AVE
CHICAGO IL
60608-5107
US

IV. Provider business mailing address

8660 S 86TH AVE APT. #316
JUSTICE IL
60458-2127
US

V. Phone/Fax

Practice location:
  • Phone: 773-869-7488
  • Fax:
Mailing address:
  • Phone: 708-572-4093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: