Healthcare Provider Details

I. General information

NPI: 1316989890
Provider Name (Legal Business Name): ANTON MLIKOTIC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21840 NORMANDIE AVE STE. 500
TORRANCE CA
90502-2047
US

IV. Provider business mailing address

21840 NORMANDIE AVE STE. 500
TORRANCE CA
90502-2047
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-5163
  • Fax: 310-222-5173
Mailing address:
  • Phone: 310-222-5163
  • Fax: 310-222-5173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA68849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: