Provider Demographics
NPI:1063222370
Name:ANTLER CLINIC PLLC
Entity type:Organization
Organization Name:ANTLER CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-899-6004
Mailing Address - Street 1:4000 W MONTROSE AVE # 568
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2140
Mailing Address - Country:US
Mailing Address - Phone:312-899-6004
Mailing Address - Fax:
Practice Address - Street 1:3346 W CULLOM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1218
Practice Address - Country:US
Practice Address - Phone:847-899-5678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health