Provider Demographics
NPI:1619184066
Name:JOSE R ANTUNES MD PA
Entity Type:Organization
Organization Name:JOSE R ANTUNES MD PA
Other - Org Name:AMERICAN DIAGNOSTIC LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANTUNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-365-0333
Mailing Address - Street 1:2400 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6223
Mailing Address - Country:US
Mailing Address - Phone:941-365-0333
Mailing Address - Fax:941-955-3181
Practice Address - Street 1:2400 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6223
Practice Address - Country:US
Practice Address - Phone:941-365-0333
Practice Address - Fax:941-955-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL8471Medicare PIN