Basic Information
| Provider Information | |||||||||
| NPI: | 1942202478 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANTON | ||||||||
| FirstName: | LEE | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 18659 TAMIAMI TRL STE A | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342877388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414293416 | ||||||||
| FaxNumber: | 9414293430 | ||||||||
| Practice Location | |||||||||
| Address1: | 18659 TAMIAMI TRL STE A | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342877388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414293416 | ||||||||
| FaxNumber: | 9414293430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 12/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/31/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD423578 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | MD423578 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207Q00000X | ME136833 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1622768 | 01 | PA | HIGHMARK | OTHER |