Provider Demographics
NPI:1285664441
Name:ANTIN, MITCHELL EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:EDWARD
Last Name:ANTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-2160
Mailing Address - Country:US
Mailing Address - Phone:412-390-3430
Mailing Address - Fax:412-683-3906
Practice Address - Street 1:5213 5TH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232
Practice Address - Country:US
Practice Address - Phone:412-390-3430
Practice Address - Fax:412-683-3906
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004985L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009943740003Medicaid
D716Medicare UPIN
PA0009943740003Medicaid