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General NPI Number Information
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NPI Number | 1780709592
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Entity Type | Organization
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Legal Business Name | JOHN J. ANTALIS, MD INC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 1502 DEERPATH DR
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City | CAMBRIDGE
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State | OH
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Zip | 43725-9240
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Country | US
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Telephone | 740-439-3020
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Fax | 740-432-5487
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Provider Business Mailing Address
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Address Line | 1502 DEERPATH DR
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City | CAMBRIDGE
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State | OH
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Zip | 43725-9240
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Country | US
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Telephone | 740-439-3020
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Fax | 740-432-5487
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Authorized Official
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Title or Position | OWNER
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Name | JOHN J ANTALIS
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Credential | MD
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Telephone | 740-439-3020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 35060862
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License Number State | OH
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