Provider Demographics
NPI:1508862590
Name:VICKI ANTON ANTHENS DPM PC
Entity Type:Organization
Organization Name:VICKI ANTON ANTHENS DPM PC
Other - Org Name:ATHENS PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:ANTONATHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-479-8383
Mailing Address - Street 1:19723 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1021
Mailing Address - Country:US
Mailing Address - Phone:734-479-8383
Mailing Address - Fax:734-479-8382
Practice Address - Street 1:19723 ALLEN RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1021
Practice Address - Country:US
Practice Address - Phone:734-479-8383
Practice Address - Fax:734-479-8382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480H278050OtherBCBSM
MI1254620001Medicare NSC
0M75510Medicare PIN
MIOM75510Medicare ID - Type Unspecified