Healthcare Provider Details

I. General information

NPI: 1649615733
Provider Name (Legal Business Name): ANNIE-LAURIE AUDEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 12/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 S WOOD ST 469 CME, M/C 724
CHICAGO IL
60612-7300
US

IV. Provider business mailing address

808 S WOOD ST 469 CME, M/C 724
CHICAGO IL
60612-7300
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-7492
  • Fax:
Mailing address:
  • Phone: 312-413-7492
  • 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: