Healthcare Provider Details

I. General information

NPI: 1134328123
Provider Name (Legal Business Name): ANCHOR PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N MIDLOTHIAN RD SUITE 400
MUNDELEIN IL
60060-1613
US

IV. Provider business mailing address

550 N MIDLOTHIAN RD SUITE 400
MUNDELEIN IL
60060-1613
US

V. Phone/Fax

Practice location:
  • Phone: 847-837-1923
  • Fax: 847-837-1924
Mailing address:
  • Phone: 847-837-1923
  • Fax: 847-837-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. SHEBA A ANTONY
Title or Position: PHYSICIAN
Credential: M.D
Phone: 847-837-1923