MEDICARE: LAURA ANTOS MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	CL1011573	OH

General Provider Information

NPI Number	:	1063839678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ANTOS MA

Provider Business Mailing Address
First Line	:	1349 E 79TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-2864
Country	:	US
Telephone Number	:	216-302-5709
Fax Number	:

Provider Business Practice Location Address
First Line	:	1349 E 79TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-2864
Country	:	US
Telephone Number	:	216-302-5709
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2014
Last Update Date	:	02/10/2026

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Directions to “ LAURA ANTOS MA” Practice Location

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