Provider Demographics
NPI:1174639017
Name:CERTO, ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:CERTO
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 1:111 N LAKEMONT AVE
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3217
Mailing Address - Country:US
Mailing Address - Phone:407-628-5838
Mailing Address - Fax:
Practice Address - Street 1:111 N LAKEMONT AVE
Practice Address - Street 2:SUITE 2E
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3217
Practice Address - Country:US
Practice Address - Phone:407-628-5838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032630207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00231386OtherRR MEDICARE NUMBER
93840Medicare ID - Type UnspecifiedMEDICARE NUMBER
D27751Medicare UPIN