Provider Demographics
NPI:1649450172
Name:ALDARONDO-ANTONINI, NEDIL (MD)
Entity type:Individual
Prefix:DR
First Name:NEDIL
Middle Name:
Last Name:ALDARONDO-ANTONINI
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 1:2545 W SILVER LAKE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2662
Mailing Address - Country:US
Mailing Address - Phone:810-243-0707
Mailing Address - Fax:810-208-0311
Practice Address - Street 1:2545 W SILVER LAKE RD STE 2
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2662
Practice Address - Country:US
Practice Address - Phone:956-286-3605
Practice Address - Fax:810-629-2377
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9972207N00000X
FLME115217207N00000X
MI4301069064207N00000X
ARE-9369207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160674101Medicaid
FL008482500Medicaid
TX8H9860OtherBLUE CROSS BLUE SHIELD
AR210918001Medicaid
AR5BD34OtherBLUE CROSS BLUE SHIELD
FL14P63OtherBLUE CROSS/BLUE SHIELD
FL14P63OtherBLUE CROSS/BLUE SHIELD
AR5BD34OtherBLUE CROSS BLUE SHIELD