Healthcare Provider Details

I. General information

NPI: 1669541868
Provider Name (Legal Business Name): SANDRA ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 W 95TH ST STE 210
OAK LAWN IL
60453-2793
US

IV. Provider business mailing address

1 N BROADWAY ST
DES PLAINES IL
60016-2335
US

V. Phone/Fax

Practice location:
  • Phone: 312-949-4200
  • Fax: 708-423-1899
Mailing address:
  • Phone: 847-298-3150
  • Fax: 847-298-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-117093
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: