Provider Demographics
NPI:1083145940
Name:PHILLIPS, LANE ANNE (MD)
Entity type:Individual
Prefix:
First Name:LANE
Middle Name:ANNE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LANE
Other - Middle Name:ANNE
Other - Last Name:GILLENWATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1622 WILLOW RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3450
Mailing Address - Country:US
Mailing Address - Phone:224-255-5600
Mailing Address - Fax:
Practice Address - Street 1:1622 WILLOW RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3450
Practice Address - Country:US
Practice Address - Phone:224-255-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036151702208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist