| Doctor Name: | VICKI MARIA ANTONATHENS |
| NPI Number: | 1407852510 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPM |
| License Number: | 5901001086 |
| Business Practice Address: | 19723 Allen Rd Brownstown Twp Brownstown Twp, MI - 481831021 |
| Business Phone Number: | 7344798383 |
| Business Fax Number: | 7344798382 |
| Mailing Address: | 19723 Allen Rd, Brownstown Twp BROWNSTOWN TWP |
| State: | MI |
| Postal Code: | 481831021 |
| Phone Number: | 7344798383 |
| Fax Number: | 7344798382 |
| NPI Enumeration Date: | 06/23/2005 |
| NPI Last Update Date: | 12/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | 5901001086 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |