Provider Demographics
NPI:1972000537
Name:MLNARIK, ANASTASIA LEA (MD)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:LEA
Last Name:MLNARIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9977 WOODS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1057
Mailing Address - Country:US
Mailing Address - Phone:847-663-8163
Mailing Address - Fax:847-663-1024
Practice Address - Street 1:9977 WOODS DR STE 200
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1057
Practice Address - Country:US
Practice Address - Phone:847-663-8163
Practice Address - Fax:847-663-1024
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036171314208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics