MEDICARE: DR. ELIAS ANTONIOU M.D.

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	2085R0202X	Diagnostic Radiology Physician	35076341	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710970900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIAS ANTONIOU M.D.

Provider Business Mailing Address
First Line	:	5700 SOUTHWYCK BLVD
Second Line	:	SUITE 100
City	:	TOLEDO
State	:	OH
Zip	:	43614-1509
Country	:	US
Telephone Number	:	800-288-8325
Fax Number	:	419-866-5453

Provider Business Practice Location Address
First Line	:	25001 EMERY RD
Second Line	:	SUITE 100
City	:	CLEVELAND
State	:	OH
Zip	:	44128-5626
Country	:	US
Telephone Number	:	216-831-9786
Fax Number	:	216-831-2425

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	06/21/2016

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