Individual
AJITHA ANTONY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12750 SAINT FRANCIS DR, CROWN POINT, IN 46307-0264
(219) 757-6005
(219) 681-6823
Mailing address
801 S WASHINGTON ST, NAPERVILLE, IL 60540-7430
(630) 527-5197
(630) 527-5197
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
01096558A
IN
208000000X
Pediatrics Physician
036115759
IL
208M00000X
Hospitalist Physician
Primary
01096558A
IN
208M00000X
Hospitalist Physician
036115759
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036115759 1
—
IL
01
—
2220936
BCBS
IL
Enumeration date
08/05/2006
Last updated
06/05/2025
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