Healthcare Provider Details

I. General information

NPI: 1063704609
Provider Name (Legal Business Name): ANAGHA LOHARIKAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 CHILDREN'S PLAZA #16
CHICAGO IL
60614
US

IV. Provider business mailing address

324 E 18TH ST
CHICAGO IL
60616-1539
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-8399
  • Fax: 773-281-4237
Mailing address:
  • Phone: 347-224-8055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number64855
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036128367
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: