Organization
KARDOUS PRIMARY CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTIOAN KARDOUS MD (PRESIDENT)
(401) 946-5001
Entity
Organization
Contact information
Practice address
1145 RESERVOIR AVE, STE 301, CRANSTON, RI 02920
(401) 946-5001
(401) 946-5101
Mailing address
1145 RESERVOIR AVE, STE 301, CRANSTON, RI 02920-6055
(401) 946-5001
(401) 946-5101
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
10089
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
272209
BLUE CROSS BLUE SHIELD
RI
01
—
408195
BLUE CHIP
RI
05
—
9003208
—
RI
01
—
DB0254
RAILROAD MEDICARE
—
Enumeration date
11/28/2005
Last updated
05/16/2018
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