Provider Demographics
NPI:1346293883
Name:ANTIC, NENAD (MC)
Entity Type:Individual
Prefix:
First Name:NENAD
Middle Name:
Last Name:ANTIC
Suffix:
Gender:M
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18000 STUDEBAKER RD STE 800
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2671
Mailing Address - Country:US
Mailing Address - Phone:562-735-3226
Mailing Address - Fax:
Practice Address - Street 1:1513 S GRAND AVE STE 360
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3465
Practice Address - Country:US
Practice Address - Phone:213-246-2422
Practice Address - Fax:213-246-2019
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31592207RH0003X
CA169820207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ112600Medicaid
AZ110081Medicare ID - Type Unspecified
AZ112600Medicaid