Provider Demographics
NPI:1558376368
Name:MALIAKKAL, ANTO VARGHESE (MD HMDC)
Entity Type:Individual
Prefix:DR
First Name:ANTO
Middle Name:VARGHESE
Last Name:MALIAKKAL
Suffix:
Gender:M
Credentials:MD HMDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8S165 S VINE ST
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5541
Mailing Address - Country:US
Mailing Address - Phone:630-835-7613
Mailing Address - Fax:
Practice Address - Street 1:8S165 S VINE ST
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-5541
Practice Address - Country:US
Practice Address - Phone:630-835-7613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54950207R00000X, 207RH0002X
IN01042537A207R00000X, 207RH0002X
IL0366083220207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF29143Medicare UPIN