Provider Demographics
NPI:1144456187
Name:LAAKE, ANN
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:LAAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 S HUMPHREY AVE
Mailing Address - Street 2:APT. 2
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2403
Mailing Address - Country:US
Mailing Address - Phone:574-850-7829
Mailing Address - Fax:
Practice Address - Street 1:100 SPALDING DR
Practice Address - Street 2:SUITE 202
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6550
Practice Address - Country:US
Practice Address - Phone:202-741-2241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036135247207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease