Healthcare Provider Details

I. General information

NPI: 1639356025
Provider Name (Legal Business Name): JAMES PRAVEEN ANTHONY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 GLENDALE BLVD SUITE 103
VALPARAISO IN
46383-3767
US

IV. Provider business mailing address

1101 GLENDALE BLVD SUITE 103
VALPARAISO IN
46383-3767
US

V. Phone/Fax

Practice location:
  • Phone: 219-464-9054
  • Fax: 219-465-1749
Mailing address:
  • Phone: 219-464-9054
  • Fax: 219-465-1749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036.125048
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01071016A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01071016A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01071016A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036.125048
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.125048
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: