Kathleen Antonetti, MD, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

KATHLEEN ANTONETTI, MD, LLC

Practice address

305 Bluestem Dr
Elgin, SC 29045-2103

Phone

(337) 991-9276

NPI assigned

Jan 20, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathleen Antonetti, MD

Title

Owner

Phone

(337) 991-9276

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484870400000",
    "number": "1164969796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60394",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705960394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 BLUESTEM DR",
            "city": "ELGIN",
            "state": "SC",
            "postal_code": "290452103",
            "telephone_number": "337-991-9276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHLEEN ANTONETTI, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-20",
        "last_updated": "2017-01-20",
        "status": "A",
        "authorized_official_last_name": "ANTONETTI",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-991-9276",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Elgin, SC
• Providers in Elgin, SC by specialty
• Internal Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.