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General NPI Number Information
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NPI Number | 1194454868
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Entity Type | Individual
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Provider Name | RYAN ANTONAWICH DO
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Gender | Male
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 983075 NEBRAKSA MEDICAL CENTER
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City | OMAHA
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State | NE
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Zip | 68198-2151
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Country | US
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Telephone | 402-559-0268
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Fax |
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Provider Business Mailing Address
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Address Line | 983075 NEBRAKSA MEDICAL CENTER
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City | OMAHA
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State | NE
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Zip | 68198-3075
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Country | US
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Telephone | 402-559-0268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 5101027619
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 5151015844
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 10177
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License Number State | NE
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