Provider Demographics
NPI:1699860585
Name:AGNONE, EUGENE JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:JOHN
Last Name:AGNONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:239-432-8331
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:18223 E 10 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5821
Practice Address - Country:US
Practice Address - Phone:586-778-5880
Practice Address - Fax:586-778-4362
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301036516207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4075028-10Medicaid