Provider Demographics
NPI:1013972876
Name:ANTAKI, JEAN-PIERRE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN-PIERRE
Middle Name:E
Last Name:ANTAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 S CHEVY CHASE DR
Mailing Address - Street 2:#105
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4431
Mailing Address - Country:US
Mailing Address - Phone:818-242-5299
Mailing Address - Fax:818-637-7607
Practice Address - Street 1:801 S CHEVY CHASE DR
Practice Address - Street 2:#105
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4431
Practice Address - Country:US
Practice Address - Phone:818-242-5299
Practice Address - Fax:818-637-7607
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAF13854207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44202Medicare UPIN