# KATHLEEN ANTONETTI, MD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164969796
- **Authorized official:** KATHLEEN ANTONETTI MD (OWNER)
- **Authorized official phone:** (337) 991-9276

## Contact information

- **Practice address:** 305 BLUESTEM DR, ELGIN, SC 29045-2103
- **Practice address phone:** (337) 991-9276
- **Mailing address:** PO BOX 60394, LAFAYETTE, LA 70596-0394

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/20/2017
- **Last updated:** 01/20/2017