Healthcare Provider Details

I. General information

NPI: 1275842924
Provider Name (Legal Business Name): ANTONY K JOSEPH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 WEST HARRISON STREET
CHICAGO IL
60612
US

IV. Provider business mailing address

7701 QUEENS CT
DOWNERS GROVE IL
60516-4423
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-6000
  • Fax:
Mailing address:
  • Phone: 630-531-8378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1-250-540-75
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: