Individual
MICHAEL CONSTANTINE ANTONELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2800 MAIN STREET DEPT OF SURGERY, BRIDGEPORT, CT 06606
(475) 210-6512
Mailing address
1290 SILAS DEANE HWY, WETHERSFIELD, CT 06109-4337
(203) 909-4171
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6627
CT
363A00000X
Physician Assistant
—
—
Other
Enumeration date
09/16/2021
Last updated
09/18/2024
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