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General NPI Number Information
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NPI Number | 1164969796
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Entity Type | Organization
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Legal Business Name | KATHLEEN ANTONETTI, MD, LLC
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 305 BLUESTEM DR
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City | ELGIN
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State | SC
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Zip | 29045-2103
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Country | US
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Telephone | 337-991-9276
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 60394
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City | LAFAYETTE
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State | LA
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Zip | 70596-0394
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN ANTONETTI
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Credential | MD
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Telephone | 337-991-9276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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