Basic Information
| Provider Information | |||||||||
| NPI: | 1639358195 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THOMAS J. ANTALIK, MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3193 | ||||||||
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| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277153193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195446318 | ||||||||
| FaxNumber: | 9195446336 | ||||||||
| Practice Location | |||||||||
| Address1: | 511 RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | ROXBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275734627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365975462 | ||||||||
| FaxNumber: | 3365979428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2007 | ||||||||
| LastUpdateDate: | 10/31/2007 | ||||||||
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| AuthorizedOfficialLastName: | SHELTON | ||||||||
| AuthorizedOfficialFirstName: | TRENT | ||||||||
| AuthorizedOfficialMiddleName: | O | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING | ||||||||
| AuthorizedOfficialTelephone: | 9195446318 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.