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General NPI Number Information
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NPI Number | 1396974226
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Entity Type | Organization
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Legal Business Name | ANTONIOU FAMILY MEDICINE, S.C.
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Dates
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Enumeration Date | 07/13/2009
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Last Update Date | 07/06/2010
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Provider Practice Location Address
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Address Line | 1601 SW ARCHER RD
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City | GAINESVILLE
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State | FL
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Zip | 32608-1135
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Country | US
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Telephone | 352-376-1611
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 SW ARCHER ROAD
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City | GAINESVILLE
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State | FL
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Zip | 32608
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Country | US
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Telephone | 352-376-1611
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NIKOLAS ANTONIOU
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Credential | M.D.
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Telephone | 630-240-5779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036098315
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License Number State | IL
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