Healthcare Provider Details

I. General information

NPI: 1700924941
Provider Name (Legal Business Name): MICHAEL J ANTONINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11795 EDUCATION ST STE 201
AUBURN CA
95602-2469
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 530-745-0720
  • Fax: 530-745-0718
Mailing address:
  • Phone: 191-670-8803
  • Fax: 530-823-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG84850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: