Provider Demographics
NPI:1245249218
Name:ANTOINE, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ANTOINE
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 1:2501 N COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4131
Mailing Address - Country:US
Mailing Address - Phone:954-357-1172
Mailing Address - Fax:954-357-1175
Practice Address - Street 1:2501 N COMMERCIAL BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-357-1172
Practice Address - Fax:954-357-1175
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1818752084P0800X
FLME721942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01842066Medicaid
FL001565500Medicaid
NY01842066Medicaid
FLCQ263ZMedicare PIN
FLDU997AMedicare PIN
NY85K581Medicare ID - Type Unspecified