Healthcare Provider Details

I. General information

NPI: 1124088455
Provider Name (Legal Business Name): KATHY ANN ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY ANN HUSSONG MD

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 GATEWAY DR
SYCAMORE IL
60178
US

IV. Provider business mailing address

2240 GATEWAY DR
SYCAMORE IL
60178
US

V. Phone/Fax

Practice location:
  • Phone: 815-756-8571
  • Fax: 815-756-1790
Mailing address:
  • Phone: 815-756-8571
  • Fax: 815-756-1790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036071921
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: