Provider Demographics
NPI:1205820073
Name:ANTAO, SARTO I (MD)
Entity Type:Individual
Prefix:
First Name:SARTO
Middle Name:I
Last Name:ANTAO
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 1:401 REYNOLDS DR
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3726
Mailing Address - Country:US
Mailing Address - Phone:765-453-0802
Mailing Address - Fax:765-455-4258
Practice Address - Street 1:401 REYNOLDS DR
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3726
Practice Address - Country:US
Practice Address - Phone:765-453-0802
Practice Address - Fax:765-455-4258
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028289A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCO3737Medicare UPIN
IN362600DMedicare ID - Type Unspecified