Kathleen Antonetti, Md, Llc | |
305 Bluestem Dr Elgin SC 29045-2103 | |
(337) 991-9276 | |
Not Available |
Full Name | Kathleen Antonetti, Md, Llc |
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Speciality | Internal Medicine |
Location | 305 Bluestem Dr, Elgin, South Carolina |
Authorized Official Name and Position | Kathleen Antonetti (OWNER) |
Authorized Official Contact | 3379919276 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Kathleen Antonetti, Md, Llc Po Box 60394 Lafayette LA 70596-0394 Ph: () - | Kathleen Antonetti, Md, Llc 305 Bluestem Dr Elgin SC 29045-2103 Ph: (337) 991-9276 |
NPI Number | 1164969796 |
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Provider Enumeration Date | 01/20/2017 |
Last Update Date | 01/20/2017 |
Medicare PECOS PAC ID | 4486938545 |
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Medicare Enrollment ID | O20170309000658 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164969796 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Kathleen L Antonetti |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1598786188 PECOS PAC ID: 1850368424 Enrollment ID: I20050919000764 |
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