Provider Demographics
NPI:1669438842
Name:JAROS, ANTONIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIN
Middle Name:
Last Name:JAROS
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 1:105 MAUI LANI PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2443
Mailing Address - Country:US
Mailing Address - Phone:480-740-2106
Mailing Address - Fax:
Practice Address - Street 1:105 MAUI LANI PKWY STE 100
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2443
Practice Address - Country:US
Practice Address - Phone:480-740-2106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31852207R00000X
HI19943207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ862898-01Medicaid
AZ280856Medicare PIN
AZ862898-01Medicaid
AZZ80856Medicare PIN