Provider Demographics
NPI:1831291640
Name:DELEON, ANTONIO R (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:R
Last Name:DELEON
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 1:1221 S ORTONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-8676
Mailing Address - Country:US
Mailing Address - Phone:248-627-4978
Mailing Address - Fax:248-627-4927
Practice Address - Street 1:1221 S ORTONVILLE RD
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-8676
Practice Address - Country:US
Practice Address - Phone:248-627-4978
Practice Address - Fax:248-627-4927
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301048944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3235468Medicaid
MIB46690Medicare UPIN
MI3235468Medicaid