MEDICARE: STEPHEN ANTWI M.D.

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	208000000X	Pediatrics Physician	L6264	TX
2	207P00000X	Emergency Medicine Physician	L6264	TX
3	207R00000X	Internal Medicine Physician	L6264	TX

General Provider Information

NPI Number	:	1922038223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN ANTWI M.D.

Provider Business Mailing Address
First Line	:	2012 LAKE LANDING DR
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-7801
Country	:	US
Telephone Number	:	409-771-1357
Fax Number	:

Provider Business Practice Location Address
First Line	:	2925 GULF FWY S STE B-348
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-6768
Country	:	US
Telephone Number	:	409-771-1357
Fax Number	:

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	04/15/2020

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