MEDICARE: ANTRONE MCINTOSH

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
1	172A00000X	Driver	M25301084253	IL

General Provider Information

NPI Number	:	1891567699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTRONE MCINTOSH

Provider Business Mailing Address
First Line	:	409 WATSEKA ST
Second Line	:
City	:	PARK FOREST
State	:	IL
Zip	:	60466-1307
Country	:	US
Telephone Number	:	773-648-3680
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 WATSEKA ST
Second Line	:
City	:	PARK FOREST
State	:	IL
Zip	:	60466-1307
Country	:	US
Telephone Number	:	773-648-3680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2023
Last Update Date	:	10/25/2023

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Directions to “ ANTRONE MCINTOSH ” Practice Location

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