Provider Demographics
NPI:1669692570
Name:RECINTO, ANTONIO RECIO (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:RECIO
Last Name:RECINTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A
Other - Middle Name:R
Other - Last Name:RECINTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:431 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-1317
Mailing Address - Country:US
Mailing Address - Phone:765-649-2234
Mailing Address - Fax:765-640-0538
Practice Address - Street 1:431 W 9TH ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-1317
Practice Address - Country:US
Practice Address - Phone:765-649-2234
Practice Address - Fax:765-640-0538
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010261652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100117570Medicaid
IN677070Medicare ID - Type Unspecified
IN100117570Medicaid