Provider Demographics
NPI:1194720532
Name:ALCANTARA, ANTHONY L (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:L
Last Name:ALCANTARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36175 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-3274
Mailing Address - Country:US
Mailing Address - Phone:586-741-3772
Mailing Address - Fax:586-741-4604
Practice Address - Street 1:36175 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-3274
Practice Address - Country:US
Practice Address - Phone:586-741-3772
Practice Address - Fax:586-741-4604
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010545152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0H26188032OtherFED BLACK LUNG PROGRAM
MI0Q26008OtherBCBS PROVIDER NUMBER
0Q26008055OtherFREDERAL BLACK LUNG
MI1006439OtherMCLAREN HEALTH
MI143536OtherGREAT LAKES HEALTH
P00063034OtherPALMETTO GBA RAILROAD MED
MI1194720532Medicaid
MI455311710OtherPRO CARE
MI1006439OtherMCLAREN HEALTH
MI143536OtherGREAT LAKES HEALTH
MI1194720532Medicaid