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General NPI Number Information
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NPI Number | 1922046457
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Entity Type | Individual
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Provider Name | ANNA ILLNER M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 06/27/2024
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Provider Practice Location Address
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Address Line | 6621 FANNIN ST
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City | HOUSTON
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State | TX
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Zip | 77030-2358
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Country | US
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Telephone | 832-824-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE SUITE 200
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone | 317-962-4836
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Fax | 317-962-8646
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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 | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 01057644
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 01057644
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 01057644
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | M5238
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License Number State | TX
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