MEDICARE: DR. NEDIL ALDARONDO-ANTONINI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	K9972	TX
2	207N00000X	Dermatology Physician	ME115217	FL
3	207N00000X	Dermatology Physician	4301069064	MI
4	207N00000X	Dermatology Physician	E-9369	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8H9860	OTHER	TX	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	5BD34	OTHER	AR	BLUE CROSS BLUE SHIELD
6	14P63	OTHER	FL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1649450172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEDIL ALDARONDO-ANTONINI M.D.

Provider Business Mailing Address
First Line	:	2545 W SILVER LAKE RD STE 2
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-2662
Country	:	US
Telephone Number	:	810-243-0707
Fax Number	:	810-208-0311

Provider Business Practice Location Address
First Line	:	2545 W SILVER LAKE RD STE 2
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-2662
Country	:	US
Telephone Number	:	956-286-3605
Fax Number	:	810-629-2377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	05/13/2024

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Directions to “ DR. NEDIL ALDARONDO-ANTONINI M.D.” Practice Location

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