Provider Demographics
NPI:1174563035
Name:ANTIL, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:ANTIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8798
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:
Practice Address - Street 1:200 PAVILION WAY
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4561
Practice Address - Country:US
Practice Address - Phone:910-255-4400
Practice Address - Fax:910-235-3449
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0404165OtherEVERCARE
NC5902368Medicaid
NC139KOOtherBC/BS NC PROVIDER#
NCE2542OtherMEDCOST PROVIDER#
SCN0015DOtherSC MEDICAID PROVIDER #
NCP00237239OtherPALMETTO GBA PROVIDER#
NCFH2967115OtherFIRSTCAROLINACAREPROV.#
NCP00237239OtherPALMETTO GBA PROVIDER#
I29850Medicare UPIN