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JOHN VITO ANTONUCCI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
70 FULTON ST, PONTIAC, MI 48341-2755
(248) 338-0300
(248) 338-0663
Mailing address
2234 COLONIAL BLVD, ATTN: PAYER CONTRACTING & RELATIONS, FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
4301081739
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1046261
HEALTH PLUS OF MICHIGAN THRU OAKLAND PHYSICIANS NETWORK SERVICES (OPNS)
MI
01
200811
UNITED HEALTHCARE COMMUNITY PLAN
MI
01
9209246
AETNA THRU OAKLAND PHYSICIANS NETWORK SERVICES
MI
01
P01013930
RAILROAD MEDICARE
MI
Enumeration date
05/10/2007
Last updated
10/29/2012
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