Provider Demographics
NPI:1487995437
Name:VERGHESE, ANTONY KURIAN (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONY
Middle Name:KURIAN
Last Name:VERGHESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:217-383-6941
Mailing Address - Fax:
Practice Address - Street 1:311 W FAIRCHILD ST
Practice Address - Street 2:ADULT MED
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3876
Practice Address - Country:US
Practice Address - Phone:217-431-7700
Practice Address - Fax:217-431-7634
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT203101207R00000X
IL036141831207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine