Antonsen, Ingrid C.

Antonsen, Ingrid C. is an individual health care provider with primary practice located at 1801 Windsor Rd , Champaign IL 61822-6217. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Antonsen, Ingrid C. can be contacted via phone (217) 366-6104.

Contact Information

Primary practice address
1801 Windsor Rd Champaign IL 61822-6217
Phone: (217) 366-6104
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036-077650 Illinois

Profile Details

NPI number 1508870601
LBN Legal business name Antonsen, Ingrid C.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2006
Last updated Sep 25th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508870601 NPPES
Illinois MEDICAID 036077650-2
Illinois Other 279500
Illinois Other 080065701

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