Basic Information
| Provider Information | |||||||||
| NPI: | 1518971167 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOROBA | ||||||||
| FirstName: | ANNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 781 | ||||||||
| Address2: | |||||||||
| City: | KANKAKEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609010781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159357256 | ||||||||
| FaxNumber: | 8159357340 | ||||||||
| Practice Location | |||||||||
| Address1: | 380 W NORTH ST | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604429839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154784891 | ||||||||
| FaxNumber: | 8154785498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 09/10/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 036-079194 | IL | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 036079194 | 05 | IL | MEDICAID |