Healthcare Provider Details

I. General information

NPI: 1245157684
Provider Name (Legal Business Name): ANTHONY DOUKAS PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 JOHN D PAIGE DR
JOLIET IL
60431-4027
US

IV. Provider business mailing address

24150 W MAIN ST STE 202
PLAINFIELD IL
60544-2853
US

V. Phone/Fax

Practice location:
  • Phone: 219-730-6637
  • Fax:
Mailing address:
  • Phone: 219-730-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number060597572
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: