Healthcare Provider Details

I. General information

NPI: 1629166806
Provider Name (Legal Business Name): ANN T. CUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 W ROOSEVELT RD 2ND FLOOR
CHICAGO IL
60608-1316
US

IV. Provider business mailing address

1640 W ROOSEVELT RD 2ND FLOOR
CHICAGO IL
60608-1316
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-1849
  • Fax: 312-996-2472
Mailing address:
  • Phone: 312-413-1849
  • Fax: 312-996-2472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: