Healthcare Provider Details

I. General information

NPI: 1598566416
Provider Name (Legal Business Name): ANEK JENA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

3551 SAN PABLO RD S APT 602
JACKSONVILLE FL
32224-3902
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-6730
  • Fax: 773-665-3401
Mailing address:
  • Phone: 904-767-2166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: