Provider Demographics
NPI:1598889370
Name:ALLEN, ANNE C
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:C
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:901 BIESTERFIELD RD STE 310
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-7324
Practice Address - Country:US
Practice Address - Phone:847-952-9332
Practice Address - Fax:847-952-9338
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001963363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL8312003OtherMEDICARE
ILQ41040Medicare UPIN
IL635040Medicare PIN
ILK16564Medicare PIN