MEDICARE: ANN E KINNEALEY MD PC

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
1	207RH0003X	Hematology & Oncology Physician	036050081	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588659130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN E KINNEALEY MD PC

Provider Business Mailing Address
First Line	:	9266 PAYSPHERE CIRCLE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0052
Country	:	US
Telephone Number	:	847-869-2076
Fax Number	:	847-475-3414

Provider Business Practice Location Address
First Line	:	800 AUSTIN ST
Second Line	:	STE 557
City	:	EVANSTON
State	:	IL
Zip	:	60202-3439
Country	:	US
Telephone Number	:	847-869-2076
Fax Number	:	847-475-3414

Authorized Official
Title or Position	:	ONCOLOGIST
Name	:	MRS. ANN ELIZABETH KINNEALEY
Credential	:	MD
Telephone Number	:	847-869-2076

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	11/06/2008

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