# MARK C. ANTONISHEN, M.D., P.L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861681819
- **Authorized official:** MARK C ANTONISHEN M.D. (PRESIDENT)
- **Authorized official phone:** (231) 487-6030

## Contact information

- **Practice address:** 405 N DIVISION RD, STE 3, PETOSKEY, MI 49770-9045
- **Practice address phone:** (231) 487-6030
- **Practice address fax:** (231) 487-6010
- **Mailing address:** 405 N DIVISION RD, STE 3, PETOSKEY, MI 49770-9045
- **Mailing address phone:** (231) 487-6030
- **Mailing address fax:** (231) 487-6010

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 4301046169 | MI | Yes |

## Other

- **Enumeration date:** 10/16/2007
- **Last updated:** 10/16/2007