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General NPI Number Information
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NPI Number | 1588659130
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Entity Type | Organization
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Legal Business Name | ANN E KINNEALEY MD PC
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 800 AUSTIN ST STE 557
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City | EVANSTON
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State | IL
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Zip | 60202-3439
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Country | US
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Telephone | 847-869-2076
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Fax | 847-475-3414
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Provider Business Mailing Address
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Address Line | 9266 PAYSPHERE CIRCLE
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City | CHICAGO
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State | IL
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Zip | 60674-0052
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Country | US
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Telephone | 847-869-2076
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Fax | 847-475-3414
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Authorized Official
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Title or Position | ONCOLOGIST
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Name | MRS. ANN ELIZABETH KINNEALEY
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Credential | MD
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Telephone | 847-869-2076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 036050081
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License Number State | IL
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