Organization
JOHN J. ANTALIS, MD INC
Active
Parent organization
JOHN J. ANTALIS, MD
Other names
John J. Antalis, MD INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
JOHN J. ANTALIS, MD
Authorized official
JOHN J ANTALIS MD (OWNER)
(740) 439-3020
Entity
Organization
Contact information
Practice address
1502 DEERPATH DR, CAMBRIDGE, OH 43725-9240
(740) 439-3020
(740) 432-5487
Mailing address
1502 DEERPATH DR, CAMBRIDGE, OH 43725-9240
(740) 439-3020
(740) 432-5487
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
RAILROAD MEDICARE
OH
01
—
DG0782
RRB/ MEDICARE GROUP
OH
Enumeration date
03/20/2007
Last updated
05/04/2016
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