Healthcare Provider Details

I. General information

NPI: 1750476784
Provider Name (Legal Business Name): ALFRED ANTONETTI MD AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 W. PLANO PKWY
PLANO TX
75093-4640
US

IV. Provider business mailing address

6020 W. PLANO PKWY
PLANO TX
75093-4640
US

V. Phone/Fax

Practice location:
  • Phone: 469-429-7558
  • Fax: 972-543-2499
Mailing address:
  • Phone: 469-429-7558
  • Fax: 972-543-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberE1491
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberM3861
License Number StateTX

VIII. Authorized Official

Name: DR. ALFRED R ANTONETTI
Title or Position: FOUNDER
Credential: M.D.
Phone: 469-429-7558