Healthcare Provider Details

I. General information

NPI: 1083391643
Provider Name (Legal Business Name): ANTOINE KHARSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21021 N 56TH ST
PHOENIX AZ
85054-5565
US

IV. Provider business mailing address

21021 N 56TH ST
PHOENIX AZ
85054-5565
US

V. Phone/Fax

Practice location:
  • Phone: 314-359-3593
  • Fax:
Mailing address:
  • Phone: 314-359-3593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2023016870
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: