Provider Demographics
NPI:1265186720
Name:CONDURAT, ANTOANETA L
Entity type:Individual
Prefix:DR
First Name:ANTOANETA
Middle Name:L
Last Name:CONDURAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3837 KIRK ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3419
Mailing Address - Country:US
Mailing Address - Phone:847-241-8373
Mailing Address - Fax:847-241-8373
Practice Address - Street 1:6677 N LINCOLN AVE STE 310
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3634
Practice Address - Country:US
Practice Address - Phone:847-241-8373
Practice Address - Fax:847-241-8373
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181.000408133N00000X, 204C00000X, 172P00000X, 2081S0010X, 208VP0000X, 172P00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No174400000XOther Service ProvidersSpecialist
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine