Provider Demographics
NPI:1750476784
Name:ALFRED ANTONETTI MD AND ASSOCIATES
Entity Type:Organization
Organization Name:ALFRED ANTONETTI MD AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANTONETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-429-7558
Mailing Address - Street 1:6020 W. PLANO PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4640
Mailing Address - Country:US
Mailing Address - Phone:469-429-7558
Mailing Address - Fax:972-543-2499
Practice Address - Street 1:6020 W. PLANO PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4640
Practice Address - Country:US
Practice Address - Phone:469-429-7558
Practice Address - Fax:972-543-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1491208200000X
TXM38612086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB131668Medicare PIN
TXC12895Medicare UPIN
12355Medicare PIN
TXC12895Medicare UPIN
TX209883201Medicaid
TX0894826-01Medicaid