Provider Demographics
NPI:1003443763
Name:DI PONIO, ANTHONY PETER (DO)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:PETER
Last Name:DI PONIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 HIGHLAND RD STE 230
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1973
Mailing Address - Country:US
Mailing Address - Phone:248-254-8900
Mailing Address - Fax:
Practice Address - Street 1:5220 HIGHLAND RD STE 230
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1973
Practice Address - Country:US
Practice Address - Phone:248-254-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151014447207Y00000X
390200000X
MI5101028420207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program