Provider Demographics
NPI:1699114447
Name:LOUIS B ANTOINE MD FAAP PA
Entity type:Organization
Organization Name:LOUIS B ANTOINE MD FAAP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANTOINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-249-1984
Mailing Address - Street 1:11979 SW 55 STREET
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-3310
Mailing Address - Country:US
Mailing Address - Phone:954-249-1984
Mailing Address - Fax:
Practice Address - Street 1:4801 S UNIVERSITY DR
Practice Address - Street 2:SUITE 239
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3839
Practice Address - Country:US
Practice Address - Phone:954-249-1984
Practice Address - Fax:954-434-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME454662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006682800Medicaid
FL34012OtherBC BS FLORIDA
FLME45466OtherSTATE LICENSE