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NPI Code Detail

MEDICARE: ANNE MARIE VIOLLT M.D.

MEDICARE: ANNE MARIE VIOLLT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QS0010XSports Medicine (Family Medicine) Physician036146090IL
2207Q00000XFamily Medicine Physician036146090IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1036146090OTHERILSTATE LICENSE

General Provider Information

NPI Number : 1093197220
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNE MARIE VIOLLT M.D.
Provider Business Mailing Address
First Line : 2650 RIDGE AVE STE 1223
Second Line :
City : EVANSTON
State : IL
Zip : 60201-1700
Country : US
Telephone Number : 847-570-2040
Fax Number : 847-733-5315
Provider Business Practice Location Address
First Line : 199 W RAND RD STE 203
Second Line :
City : MOUNT PROSPECT
State : IL
Zip : 60056-1157
Country : US
Telephone Number : 847-618-5450
Fax Number : 847-618-5459
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2015
Last Update Date : 02/16/2026

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Directions to “ ANNE MARIE VIOLLT M.D.” Practice Location

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