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General NPI Number Information
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NPI Number | 1497286348
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Entity Type | Individual
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Provider Name | MARIKA-FOTENI ANTIMISIARIS MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 4915 NORTON HEALTHCARE BLVD STE 301
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City | LOUISVILLE
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State | KY
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Zip | 40241-2866
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Country | US
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Telephone | 502-394-6460
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Fax | 502-394-6465
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084E0001X
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Taxonomy Name | Epilepsy Physician
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License Number | 60584
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2084E0001X
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Taxonomy Name | Epilepsy Physician
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License Number | 332417
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 2084E0001X
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Taxonomy Name | Epilepsy Physician
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License Number | 01096482A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 60584
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License Number State | KY
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Taxonomy #5
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 01096482A
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License Number State | IN
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