MEDICARE: ANNIE LAMORENA CALLANGAN 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
1	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1679607196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE LAMORENA CALLANGAN M.D.

Provider Business Mailing Address
First Line	:	6427 N KENTON AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-3414
Country	:	US
Telephone Number	:	847-677-2445
Fax Number	:	773-989-1673

Provider Business Practice Location Address
First Line	:	4753 N ELSTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-4002
Country	:	US
Telephone Number	:	773-989-3845
Fax Number	:	773-989-1673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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