Elizabeth A Antoo, MD
Individual provider Active NPI Family Medicine Physician · Kenosha, WI
NPI 1760422240 · NPPES record last updated Nov 18, 2021
Key facts
- NPI
- 1760422240
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 49010 (WI)
- Practice address
- 10400 75TH St
Kenosha, WI 53142-7884 - Phone
- (262) 948-7000
- NPI assigned
- Jun 7, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111012000350 | IL | Practitioner - Family Practice | 7517974355 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advocate Health and Hospitals Corporation | Current |
Accepting new patients | |
| Advocate Health and Hospitals Corporation | Current |
Accepting new patients | |
| Aurora Medical Group, Inc. | Past | Accepting new patients |
Locations
135 N Arlington Heights Rd
Buffalo Grove, IL 60089
Phone (847) 215-8866
214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160
29373 Network Pl
Chicago, IL 60673
1775 W Dempster St
Park Ridge, IL 60068
Phone (847) 723-5150
Interoperability endpoints
- eantoo195126@direct.myadvocateaurora.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 49010 | WI | Yes |
Addresses
Primary practice location
10400 75TH St
Kenosha, WI 53142-7884
Mailing address
806 W Partridge LN
Mount Prospect, IL 60056-5114
Phone (847) 439-6186
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34835200 | Medicaid | WI |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | eantoo195126@direct.myadvocateaurora.org | Direct | |
| FHIR URL | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ |
Other providers in Kenosha, WI
- Mary Y. Ansari
- Ant Transport8 LLC
- Antonoff Dental, LLC
- Mary Antony
- Alby K Antoo
- Ashley Marie Anzalone
- Apex ASC Kenosha LLC
- Carmen Rosa Aponte
- Kelly Appelhans
- Applewhite Dental Wisconsin, P.C.
All providers in Kenosha, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.