Provider Demographics
NPI:1568574119
Name:PAVONE, ANTHONY A (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:A
Last Name:PAVONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5155 NORKO DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3021
Mailing Address - Country:US
Mailing Address - Phone:810-230-7532
Mailing Address - Fax:810-230-7764
Practice Address - Street 1:5051 VILLA LINDE PKWY STE 29
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3449
Practice Address - Country:US
Practice Address - Phone:810-732-4320
Practice Address - Fax:810-732-5830
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101006095207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E25515Medicare UPIN