Provider Demographics
NPI:1235126905
Name:VIGLIOTTI, ANTONIO P (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:P
Last Name:VIGLIOTTI
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:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-0115
Mailing Address - Country:US
Mailing Address - Phone:319-826-3763
Mailing Address - Fax:888-609-6019
Practice Address - Street 1:1401 W CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-1707
Practice Address - Country:US
Practice Address - Phone:563-421-1900
Practice Address - Fax:563-421-1938
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0835222085R0001X
IA248692085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0973826Medicaid
IA0973826Medicaid
IAA14521Medicare UPIN
IAI7423Medicare PIN