Individual
DR. INGRID C. ANTONSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1801 WINDSOR RD, CHAMPAIGN, IL 61822-6217
(217) 366-6104
Mailing address
1801 WINDSOR RD, CHAMPAIGN, IL 61822-6217
(217) 366-6104
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-077650
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036077650-2
—
IL
01
—
080065701
RAILROAD MEDICARE
IL
01
—
279500
MEDICARE GROUP
IL
Enumeration date
07/27/2006
Last updated
09/25/2008
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