Provider Demographics
NPI:1457309288
Name:ANTUN, RAFAEL A (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:A
Last Name:ANTUN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7600 SW 57 AVE
Mailing Address - Street 2:STE 213
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5408
Mailing Address - Country:US
Mailing Address - Phone:305-548-4005
Mailing Address - Fax:305-548-4055
Practice Address - Street 1:7600 SW 57 AVE
Practice Address - Street 2:STE 213
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5408
Practice Address - Country:US
Practice Address - Phone:305-548-4005
Practice Address - Fax:305-548-4055
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0059386208800000X
FLME59386208800000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111349100Medicaid
FL052240600Medicaid
FL11876AMedicare ID - Type Unspecified