Provider Demographics
NPI:1679607196
Name:CALLANGAN, ANNIE LAMORENA (MD)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:LAMORENA
Last Name:CALLANGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6427 N KENTON AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3414
Mailing Address - Country:US
Mailing Address - Phone:847-677-2445
Mailing Address - Fax:773-989-1673
Practice Address - Street 1:4753 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4002
Practice Address - Country:US
Practice Address - Phone:773-989-3845
Practice Address - Fax:773-989-1673
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF46496Medicare UPIN