Provider Demographics
NPI:1376337014
Name:ANTOON, MANHAL
Entity type:Individual
Prefix:
First Name:MANHAL
Middle Name:
Last Name:ANTOON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43119 WINTERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1864
Mailing Address - Country:US
Mailing Address - Phone:248-302-4481
Mailing Address - Fax:
Practice Address - Street 1:43119 WINTERFIELD DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1864
Practice Address - Country:US
Practice Address - Phone:248-302-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI9855409251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health