Blackmun, Annessa R

Blackmun, Annessa R is an individual health care provider with primary practice located at 4350 N Broadway St Floor 2, Chicago IL 60613-1781. She recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, Podiatric Medicine & Surgery Service Providers / Podiatrist. Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery is her primary health care specialty. Blackmun, Annessa R can be contacted via phone (773) 770-0140.

Contact Information

Primary practice address
4350 N Broadway St Floor 2 Chicago IL 60613-1781
Phone: (773) 770-0140
Fax: (773) 770-0141
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 2010035799 Missouri
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 016.005464 Illinois

Profile Details

NPI number 1538321047
LBN Legal business name Blackmun, Annessa R
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 26th, 2008
Last updated Mar 29th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538321047 NPPES
Missouri Other P01781390 RAILROAD MEDICARE
Missouri MEDICAID 1538321047 RAILROAD MEDICARE
Missouri Other P01796928 RAILROAD MEDICARE

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