Provider Demographics
NPI:1760742753
Name:ANTONIOLLI, MOLLY PROSKINE (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:PROSKINE
Last Name:ANTONIOLLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ELISABETH
Other - Last Name:PROSKINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:830 W END CT STE 500
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1379
Mailing Address - Country:US
Mailing Address - Phone:847-522-8900
Mailing Address - Fax:
Practice Address - Street 1:830 W END CT
Practice Address - Street 2:SUITE 500
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1365
Practice Address - Country:US
Practice Address - Phone:847-522-8900
Practice Address - Fax:847-680-6177
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.138510208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics