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NPI Code Detail

MEDICARE: DR. LAWRENCE R ANTONUCCI M.D.

MEDICARE: DR. LAWRENCE R ANTONUCCI 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
1207V00000XObstetrics & Gynecology PhysicianME41153FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
136352OTHERFLBC/BS OF FLORIDA
2204526OTHERFLAVMED

General Provider Information

NPI Number : 1942282025
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAWRENCE R ANTONUCCI M.D.
Provider Business Mailing Address
First Line : 636 DEL PRADO BLVD S
Second Line : ADMINISTRATION
City : CAPE CORAL
State : FL
Zip : 33990-2668
Country : US
Telephone Number : 239-573-5630
Fax Number : 239-573-4330
Provider Business Practice Location Address
First Line : 636 DEL PRADO BLVD S
Second Line : ADMINISTRATION
City : CAPE CORAL
State : FL
Zip : 33990-2668
Country : US
Telephone Number : 239-573-5630
Fax Number : 239-573-4330
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2005
Last Update Date : 10/26/2007

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