Provider Demographics
NPI:1760411664
Name:CAPONE, ANTONIO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:CAPONE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:39650 ORCHARD HILL PL
Mailing Address - Street 2:200
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5391
Mailing Address - Country:US
Mailing Address - Phone:248-319-0161
Mailing Address - Fax:248-319-0170
Practice Address - Street 1:3555 W 13 MILE RD
Practice Address - Street 2:LL-20
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-288-2280
Practice Address - Fax:248-288-5644
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2020-08-03
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Provider Licenses
StateLicense IDTaxonomies
MI4301075697207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E19959Medicare UPIN
MI1760411664Medicaid
MI0Q26082029Medicare PIN
MI0Q26082029Medicare PIN
MI4904938Medicaid
MI4239917Medicaid