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NPI Code Detail

MEDICARE: DR. DOMINIC PALLIPARAMBIL ANTONY MD

MEDICARE: DR. DOMINIC PALLIPARAMBIL ANTONY MD
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
12084P0800XPsychiatry Physician125IL

General Provider Information

NPI Number : 1790623650
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOMINIC PALLIPARAMBIL ANTONY MD
Provider Business Mailing Address
First Line : 7 JASMINE CT
Second Line :
City : STREAMWOOD
State : IL
Zip : 60107-1584
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-216-5536
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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