Provider Demographics
NPI:1427202589
Name:TEDESCHI, ANTHONY JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOHN
Last Name:TEDESCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CHRISTINA CIR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-3115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 CHRISTINA CIR
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-3115
Practice Address - Country:US
Practice Address - Phone:630-668-6100
Practice Address - Fax:630-668-0920
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-15
Last Update Date:2008-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036077471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine