Basic Information
| Provider Information | |||||||||
| NPI: | 1609320050 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANTONIOLI | ||||||||
| FirstName: | MYLES | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 985582 NEBRASKA MEDICAL CTR | ||||||||
| Address2: | CU DEPARTMENT OF PSYCHIATRY | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681985582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025526222 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 985582 NEBRASKA MEDICAL CTR | ||||||||
| Address2: | CU DEPARTMENT OF PSYCHIATRY | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681985582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025526222 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2016 | ||||||||
| LastUpdateDate: | 10/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | TEP7824 | NE | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.