Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 35.126029 | OH |
N | 111NI0900X | Internist | 35.126029 | OH |
Y | 207RP1001X | Pulmonary Disease | 036142926 | IL |
NPI | 1013274349 |
---|---|
Provider Name | Mariam Anis |
First Address | Lake Forest, IL 60045-1658 |
Second Address | Lake Forest, IL 60045-1658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2012 |
Last Update Date | 28/10/2021 |