# JOHN T ANTONIADES

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1437187960
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | D0058226 | MD | Yes |
| 207XS0114X | Adult Reconstructive Orthopaedic Surgery Physician | D0058226 | MD | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | D0058226 | MD | — |

## Other

- **Enumeration date:** 06/30/2006
- **Last updated:** 05/02/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 405613200 | — | MD |