Healthcare Provider Details

I. General information

NPI: 1881606499
Provider Name (Legal Business Name): MICHAEL GEORGE ANTIMISIARIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 BYPASS RD BLDG A
PIKEVILLE KY
41501-1689
US

IV. Provider business mailing address

PO BOX 432
PIKEVILLE KY
41502-0432
US

V. Phone/Fax

Practice location:
  • Phone: 606-430-2201
  • Fax: 606-218-4651
Mailing address:
  • Phone: 606-430-2201
  • Fax: 606-218-4651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number37545
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number37545
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: