Organization
PROMEDICA CENTRAL PHYSICIANS LLC
Active
Other names
Anita Antoniolli MD
Organization subpart
No
Provider details
NPI number
Authorized official
AMY L DWYER (CREDENTIALING SUPERVISOR)
(419) 824-7334
Entity
Organization
Contact information
Practice address
5308 HARROUN RD, SUITE 180, SYLVANIA, OH 43560-2114
(419) 824-6559
(419) 824-0343
Mailing address
5308 HARROUN RD, SUITE 180, SYLVANIA, OH 43560-2114
(419) 824-6559
(419) 824-0343
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
OH
2086X0206X
Surgical Oncology Physician
Primary
—
OH
Other
Enumeration date
10/09/2013
Last updated
10/09/2013
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