Provider Demographics
NPI:1306057492
Name:ANCONA, JAMES R
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:ANCONA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 ATLANTIC AVENUE
Mailing Address - Street 2:E
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-3740
Mailing Address - Country:US
Mailing Address - Phone:847-502-3630
Mailing Address - Fax:
Practice Address - Street 1:901 W BIESTERFIELD ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-7324
Practice Address - Country:US
Practice Address - Phone:847-437-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist