Healthcare Provider Details

I. General information

NPI: 1053418780
Provider Name (Legal Business Name): ANTON SCHITTEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 MAIN ST
MOUNT VERNON IL
62864-2372
US

IV. Provider business mailing address

2605 MAIN ST
MOUNT VERNON IL
62864-2372
US

V. Phone/Fax

Practice location:
  • Phone: 618-244-0050
  • Fax: 618-244-0061
Mailing address:
  • Phone: 618-244-0050
  • Fax: 618-244-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: