Healthcare Provider Details

I. General information

NPI: 1245633742
Provider Name (Legal Business Name): ANNA SERAFINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 S WOOD ST # MC796
CHICAGO IL
60612-4300
US

IV. Provider business mailing address

912 S WOOD ST # MC796
CHICAGO IL
60612-4300
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6496
  • Fax: 312-413-8215
Mailing address:
  • Phone: 312-996-6496
  • Fax: 312-413-8215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036-141671
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number036141671
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number036141671
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: