Healthcare Provider Details

I. General information

NPI: 1790584563
Provider Name (Legal Business Name): ANNA LALANDE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E ONTARIO ST
CHICAGO IL
60611-3468
US

IV. Provider business mailing address

211 E ONTARIO ST
CHICAGO IL
60611-3468
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0596
  • Fax:
Mailing address:
  • Phone: 312-695-0596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number085.012317
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: