Provider Demographics
NPI:1568785269
Name:FIORAVANTI, ANTHONY CAREY
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CAREY
Last Name:FIORAVANTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3650
Mailing Address - Country:US
Mailing Address - Phone:810-985-7297
Mailing Address - Fax:
Practice Address - Street 1:14960 E PARK ST
Practice Address - Street 2:
Practice Address - City:CAPAC
Practice Address - State:MI
Practice Address - Zip Code:48014-3177
Practice Address - Country:US
Practice Address - Phone:810-395-4343
Practice Address - Fax:810-395-2985
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker