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General NPI Number Information
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NPI Number | 1356425755
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Entity Type | Individual
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Provider Name | ANNA BUNPLOOG-LANE M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 6301 N WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60659-2009
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Country | US
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Telephone | 773-761-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 3120 EMERSON ST
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City | FRANKLIN PARK
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State | IL
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Zip | 60131-2621
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Country | US
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Telephone | 847-671-0380
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036-110715
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License Number State | IL
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