Healthcare Provider Details

I. General information

NPI: 1891863411
Provider Name (Legal Business Name): ANN RENEE COLLIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 OAKBROOK CTR SUITE 424
OAK BROOK IL
60523-1806
US

IV. Provider business mailing address

120 OAKBROOK CTR SUITE 424
OAK BROOK IL
60523-1806
US

V. Phone/Fax

Practice location:
  • Phone: 630-574-0460
  • Fax: 630-574-0470
Mailing address:
  • Phone: 630-574-0460
  • Fax: 630-574-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036118702
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number35084568
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: