MEDICARE: AJITHA ANTONY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	01096558A	IN
2	208000000X	Pediatrics Physician	036115759	IL
3	208000000X	Pediatrics Physician	01096558A	IN
4	208M00000X	Hospitalist Physician	036115759	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2220936	OTHER	IL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700895273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AJITHA ANTONY M.D.

Provider Business Mailing Address
First Line	:	801 S WASHINGTON ST
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-7430
Country	:	US
Telephone Number	:	630-527-5197
Fax Number	:	630-527-5197

Provider Business Practice Location Address
First Line	:	12750 SAINT FRANCIS DR
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-0264
Country	:	US
Telephone Number	:	219-757-6005
Fax Number	:	219-681-6823

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	06/15/2026

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Directions to “ AJITHA ANTONY M.D.” Practice Location

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