Basic Information
Provider Information
NPI: 1306096722
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MOSKAL
FirstName: ANNA
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 307 N KNIGHT AVE
Address2:  
City: PARK RIDGE
State: IL
PostalCode: 600683111
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 836 W WELLINGTON AVE
Address2:  
City: CHICAGO
State: IL
PostalCode: 606575147
CountryCode: US
TelephoneNumber: 7739751600
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/22/2008
LastUpdateDate: 10/28/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/28/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X125051366ILN Allopathic & Osteopathic PhysiciansAnesthesiology 
207L00000X036122658ILY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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