Provider Demographics
NPI:1639135601
Name:ANTOINE, MOGIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOGIN
Middle Name:
Last Name:ANTOINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 NE 125TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5746
Mailing Address - Country:US
Mailing Address - Phone:305-836-1421
Mailing Address - Fax:305-836-1442
Practice Address - Street 1:915 NE 125TH ST STE 301
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5746
Practice Address - Country:US
Practice Address - Phone:305-836-1421
Practice Address - Fax:305-836-1442
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228247-1207LP2900X
FLME86102207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265702300Medicaid
FL62797XOtherPAIN MEDICINE
FLH76554Medicare UPIN
FL265702300Medicaid