MEDICARE: MR. ANTANEE CHARLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1821976465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTANEE CHARLES

Provider Business Mailing Address
First Line	:	11525 KINGS KNIGHT CIR
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-8621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1082 TREMONT AVE
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48505-1447
Country	:	US
Telephone Number	:	810-597-7425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2025
Last Update Date	:	08/22/2025

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Directions to “ MR. ANTANEE CHARLES ” Practice Location

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