Healthcare Provider Details

I. General information

NPI: 1619311644
Provider Name (Legal Business Name): ANKITA DALAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21660 W FIELD PKWY
DEER PARK IL
60010-7265
US

IV. Provider business mailing address

21660 W FIELD PKWY
DEER PARK IL
60010-7265
US

V. Phone/Fax

Practice location:
  • Phone: 888-803-3370
  • Fax: 888-803-3331
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036141926
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD494627
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301103811
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53581
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15086320
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: