1093499311 NPI number — LIZDA LINETT ANAYA DAHUD M.D.

Table of content: LIZDA LINETT ANAYA DAHUD M.D. (NPI 1093499311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093499311 NPI number — LIZDA LINETT ANAYA DAHUD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANAYA DAHUD
Provider First Name:
LIZDA
Provider Middle Name:
LINETT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093499311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 NE GLEN OAK AVE OSF ST. FRANCIS MEDICAL
Provider Second Line Business Mailing Address:
CENTER OBGYN RESIDENCY, ATTN LAUREN KEETON
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-655-4163
Provider Business Mailing Address Fax Number:
309-655-3739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 NE GLEN OAK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-655-4163
Provider Business Practice Location Address Fax Number:
309-655-3739
Provider Enumeration Date:
06/15/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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