Individual
DR. PAVEL ANTONOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11750 SW 40TH ST, MIAMI, FL 33175-3530
(315) 223-3000
Mailing address
11750 SW 40TH ST, MIAMI, FL 33175-3530
(315) 223-3000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35.135526
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/03/2016
Last updated
05/15/2019
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