Healthcare Provider Details

I. General information

NPI: 1356425755
Provider Name (Legal Business Name): ANNA BUNPLOOG-LANE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA BUNPLOOG M.D.

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 N WESTERN AVE
CHICAGO IL
60659-2009
US

IV. Provider business mailing address

3120 EMERSON ST
FRANKLIN PARK IL
60131-2621
US

V. Phone/Fax

Practice location:
  • Phone: 773-761-0300
  • Fax:
Mailing address:
  • Phone: 847-671-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-110715
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: