Provider Demographics
NPI:1639171424
Name:AFTIMOS, ANTOUN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTOUN
Middle Name:
Last Name:AFTIMOS
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 1:1083 SUNCREST DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-4421
Mailing Address - Country:US
Mailing Address - Phone:810-667-6112
Mailing Address - Fax:810-667-6155
Practice Address - Street 1:1083 SUNCREST DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-4421
Practice Address - Country:US
Practice Address - Phone:810-667-6112
Practice Address - Fax:810-667-6155
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-10-02
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-06-27
Provider Licenses
StateLicense IDTaxonomies
MI4301062263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4534345Medicaid
MIP36120001Medicare PIN
MIG28732Medicare UPIN