Provider Demographics
NPI:1093342586
Name:ANTMAN, ELLIOTT TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:TODD
Last Name:ANTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8530 WILSHIRE BLVD STE 520
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3116
Mailing Address - Country:US
Mailing Address - Phone:310-854-0770
Mailing Address - Fax:
Practice Address - Street 1:505 S MAIN ST STE 525
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4553
Practice Address - Country:US
Practice Address - Phone:714-456-5631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1853368208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program