Provider Demographics
NPI:1457548729
Name:ANTONINI, AUDBERTO CESAR (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDBERTO
Middle Name:CESAR
Last Name:ANTONINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:203 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-5284
Mailing Address - Country:US
Mailing Address - Phone:734-398-5412
Mailing Address - Fax:734-398-5412
Practice Address - Street 1:7901 ANGLING RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-0714
Practice Address - Country:US
Practice Address - Phone:269-226-8253
Practice Address - Fax:269-226-8190
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301062716207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine