Provider Demographics
NPI:1942302120
Name:ANTONIO, NIEVES CORTES (MD)
Entity Type:Individual
Prefix:DR
First Name:NIEVES
Middle Name:CORTES
Last Name:ANTONIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 BROOKHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9439
Mailing Address - Country:US
Mailing Address - Phone:812-945-2047
Mailing Address - Fax:812-945-2047
Practice Address - Street 1:3018 BROOKHAVEN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9439
Practice Address - Country:US
Practice Address - Phone:812-945-2047
Practice Address - Fax:812-945-2047
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027716A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100374900AMedicaid
E03709Medicare UPIN
IN100374900AMedicaid