Organization
MARK C. ANTONISHEN, M.D., P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK C ANTONISHEN M.D. (PRESIDENT)
(231) 487-6030
Entity
Organization
Contact information
Practice address
405 N DIVISION RD, STE 3, PETOSKEY, MI 49770-9045
(231) 487-6030
(231) 487-6010
Mailing address
405 N DIVISION RD, STE 3, PETOSKEY, MI 49770-9045
(231) 487-6030
(231) 487-6010
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301046169
MI
Other
Enumeration date
10/16/2007
Last updated
10/16/2007
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