Healthcare Provider Details

I. General information

NPI: 1578541876
Provider Name (Legal Business Name): LYNN MICHELLE ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT STE 463
CHICAGO IL
60631
US

IV. Provider business mailing address

7447 W TALCOTT STE 463
CHICAGO IL
60631
US

V. Phone/Fax

Practice location:
  • Phone: 773-763-8400
  • Fax: 773-774-8085
Mailing address:
  • Phone: 773-763-8400
  • Fax: 773-774-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: