Active NPI
Miguel R Antonatos, M.D.
- Internal Medicine Physician
- Chicago, IL
National Provider Identifier
1912285081
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 036138839
- Practice address
- 4803 N Milwaukee Ave
Suite B Unit #220
Chicago, IL 60630 - Phone
- (973) 847-2280
- NPI assigned
- Jul 23, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036138839 | IL | |
| Hospitalist Physician | 208M00000X | 036138839 | IL | |
| Internal Medicine Physician | 207R00000X | 036138839 | IL | Primary |
Addresses
Primary practice location
4803 N Milwaukee Ave
Suite B Unit #220
Chicago, IL 60630
Mailing address
4803 N Milwaukee Ave
Suite B Unit #220
Chicago, IL 60630
Phone (973) 847-2280
Other identifiers 31
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12428 | Other | SD | SD LICENSE |
| C0084 | Other | KY | KY LICENSE |
| ME147653 | Other | FL | FL LICENSE |
| 30482 | Other | WV | WV LICENSE |
| 412-320 | Other | WI | WI LICENSE |
| 41925 | Other | AL | AL LICENSE |
| 61076 | Other | AZ | AZ LICENSE |
| C177591 | Other | CA | CA LICENSE |
| D0090753 | Other | MD | MD LICENSE |
| EMC0000064 | Other | MI | MI LICENSE |
| 28569 | Other | MS | MS LICENSE |
| 33242 | Other | NE | NE LICENSE |
| 036138839 | Other | IL | ILLIONOIS LICENSE |
| 04-44257 | Other | KS | KS LICENSE |
| 20724 | Other | NV | NV LICENSE |
| 42.0015135 | Other | VT | VT LICENSE |
| 68586 | Other | MN | MN LICENSE |
| 85397 | Other | GA | GA LICENSE |
| 25MA10452000 | Other | NJ | NJ LICENSE |
| MD-47241 | Other | IA | IA LICENSE |
| MD61023368 | Other | WA | WA LICENSE |
| 12087673-1205 | Other | UT | UT LICENSE |
| 33998 | Other | SC | SC LICENSE |
| 37913 | Other | OK | OK LICENSE |
| 60557 | Other | TN | TN LICENSE |
| 101275982 | Other | VA | VA LICENSE |
| 17108 | Other | ND | ND LICENSE |
| 21180 | Other | NH | NH LICENSE |
| 311447 | Other | NY | NY LICENSE |
| CDR.0000338 | Other | CO | CO LICENSE |
| MC-0780 | Other | ID | ID LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036138839 | IL | MD | Hospitalist Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674518400000",
"number": "1912285081",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4803 N MILWAUKEE AVE",
"address_2": "SUITE B UNIT #220",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60630",
"telephone_number": "973-847-2280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4803 N MILWAUKEE AVE",
"address_2": "SUITE B UNIT #220",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60630",
"telephone_number": "973-847-2280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTONATOS",
"first_name": "MIGUEL",
"middle_name": "R",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-23",
"last_updated": "2023-01-24",
"certification_date": "2023-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036138839",
"primary": false
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "IL",
"license": "036138839",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "036138839",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SD LICENSE",
"identifier": "12428",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KY LICENSE",
"identifier": "C0084",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FL LICENSE",
"identifier": "ME147653",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WV LICENSE",
"identifier": "30482",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WI LICENSE",
"identifier": "412-320",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AL LICENSE",
"identifier": "41925",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AZ LICENSE",
"identifier": "61076",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CA LICENSE",
"identifier": "C177591",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MD LICENSE",
"identifier": "D0090753",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MI LICENSE",
"identifier": "EMC0000064",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MS LICENSE",
"identifier": "28569",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NE LICENSE",
"identifier": "33242",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ILLIONOIS LICENSE",
"identifier": "036138839",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KS LICENSE",
"identifier": "04-44257",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NV LICENSE",
"identifier": "20724",
"state": "NV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VT LICENSE",
"identifier": "42.0015135",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN LICENSE",
"identifier": "68586",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GA LICENSE",
"identifier": "85397",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NJ LICENSE",
"identifier": "25MA10452000",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IA LICENSE",
"identifier": "MD-47241",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WA LICENSE",
"identifier": "MD61023368",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UT LICENSE",
"identifier": "12087673-1205",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SC LICENSE",
"identifier": "33998",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OK LICENSE",
"identifier": "37913",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TN LICENSE",
"identifier": "60557",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VA LICENSE",
"identifier": "101275982",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ND LICENSE",
"identifier": "17108",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NH LICENSE",
"identifier": "21180",
"state": "NH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NY LICENSE",
"identifier": "311447",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CO LICENSE",
"identifier": "CDR.0000338",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ID LICENSE",
"identifier": "MC-0780",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.