Individual
JOHN J ANTALIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1502 DEERPATH DR, CAMBRIDGE, OH 43725-9240
(740) 439-3020
Mailing address
11000 WOODLANDS TER, CAMBRIDGE, OH 43725-8883
(740) 432-6154
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
35060862
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0916003
—
OH
01
—
180036464
RRB/MEDICARE PTAN
OH
01
—
DG0782
RRB/MEDICARE GROUP
OH
Enumeration date
06/02/2005
Last updated
10/23/2012
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