Healthcare Provider Details

I. General information

NPI: 1376273573
Provider Name (Legal Business Name): ANTONIOS SKONDRAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 W HARRISON ST
CHICAGO IL
60612-3801
US

IV. Provider business mailing address

8836 OSCEOLA AVE
MORTON GROVE IL
60053-1925
US

V. Phone/Fax

Practice location:
  • Phone: 847-340-0072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036175096
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.080591
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: