Provider Demographics
NPI:1740396688
Name:ANTUNANO, EMILIO E (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:E
Last Name:ANTUNANO
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 1:1724 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1390
Mailing Address - Country:US
Mailing Address - Phone:248-673-5520
Mailing Address - Fax:248-673-1145
Practice Address - Street 1:1724 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1390
Practice Address - Country:US
Practice Address - Phone:248-673-5520
Practice Address - Fax:248-673-1145
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI405574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4089892Medicaid
MI4089892Medicaid
MIB42942Medicare UPIN