MEDICARE: DR. DAVID ANYADIKE 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	208000000X	Pediatrics Physician	036109277	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	:	1700956695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ANYADIKE M.D.

Provider Business Mailing Address
First Line	:	3037 W POLK STREET
Second Line	:	UNIT 1
City	:	CHICAGO
State	:	IL
Zip	:	60612-3906
Country	:	US
Telephone Number	:	773-826-6282
Fax Number	:	773-376-1909

Provider Business Practice Location Address
First Line	:	2738 W CERMAK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3528
Country	:	US
Telephone Number	:	773-376-1906
Fax Number	:	773-376-1909

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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