Provider Demographics
NPI:1164735692
Name:FLORES ANTICONA, EDGARDO MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:MANUEL
Last Name:FLORES ANTICONA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2101 JACKSON ST STE 110
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4386
Mailing Address - Country:US
Mailing Address - Phone:765-643-6012
Mailing Address - Fax:765-646-9054
Practice Address - Street 1:2101 JACKSON ST STE 110
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4386
Practice Address - Country:US
Practice Address - Phone:765-643-6012
Practice Address - Fax:765-646-9054
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2018-06-26
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Provider Licenses
StateLicense IDTaxonomies
IN01075839A207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine