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NPI Code Detail

MEDICARE: DR. KERSEY H ANTIA PHD

MEDICARE: DR. KERSEY H ANTIA PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistIL

General Provider Information

NPI Number : 1710962683
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KERSEY H ANTIA PHD
Provider Business Mailing Address
First Line : 8318 138TH PL
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-1746
Country : US
Telephone Number : 708-460-6060
Fax Number : 708-460-6060
Provider Business Practice Location Address
First Line : 17716 OAK PARK AVE
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-3936
Country : US
Telephone Number : 708-460-6060
Fax Number : 708-460-6060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 07/08/2007

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