Provider Demographics
NPI:1841209111
Name:ANTOLAK, CHRISTOPHER MILTON (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MILTON
Last Name:ANTOLAK
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 1:2600 39TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-4379
Mailing Address - Country:US
Mailing Address - Phone:612-706-2900
Mailing Address - Fax:612-706-2901
Practice Address - Street 1:2600 39TH AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55421-4379
Practice Address - Country:US
Practice Address - Phone:612-706-2900
Practice Address - Fax:612-706-2901
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine