Provider Demographics
NPI:1174780035
Name:HENNING, AMY ANDERSON (MD)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ANDERSON
Last Name:HENNING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:KRISTEN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:259 E ERIE ST
Mailing Address - Street 2:SUITE 2350
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2987
Mailing Address - Country:US
Mailing Address - Phone:312-926-6000
Mailing Address - Fax:312-926-6323
Practice Address - Street 1:259 E ERIE ST
Practice Address - Street 2:SUITE 2350
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2987
Practice Address - Country:US
Practice Address - Phone:312-926-6000
Practice Address - Fax:312-926-6323
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121042207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036121042Medicaid
IL036121042OtherBC/BS
ILR01374OtherMEDICARE PTAN