Healthcare Provider Details

I. General information

NPI: 1225231707
Provider Name (Legal Business Name): ANNITA JOHN M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10237 S WESTERN AVE
CHICAGO IL
60643-1917
US

IV. Provider business mailing address

10237 S WESTERN AVE
CHICAGO IL
60643-1917
US

V. Phone/Fax

Practice location:
  • Phone: 773-238-1616
  • Fax: 773-238-2660
Mailing address:
  • Phone: 773-238-1616
  • Fax: 773-238-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNITA JOHN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 773-238-1616