Healthcare Provider Details

I. General information

NPI: 1487995437
Provider Name (Legal Business Name): ANTONY KURIAN VERGHESE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W FAIRCHILD ST ADULT MED
DANVILLE IL
61832-3876
US

IV. Provider business mailing address

611 W PARK ST BWPC
URBANA IL
61801-2529
US

V. Phone/Fax

Practice location:
  • Phone: 217-431-7700
  • Fax: 217-431-7634
Mailing address:
  • Phone: 217-383-6941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number036141831
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT203101
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036141831
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: