Individual
MARIA CAROLINE ANTIQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
560 MCCELLAN ROAD, JACKSON, TN 38305
(731) 234-5717
(423) 979-6333
Mailing address
560 MCCELLAN ROAD, JACKSON, TN 38305-9688
(731) 234-5717
(423) 979-6333
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
35423
TN
207Q00000X
Family Medicine Physician
MD35423
TN
207R00000X
Internal Medicine Physician
Primary
35423
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3893940
MEDICARE
TN
05
—
3893940
—
TN
01
—
4105658
BCBS
—
Enumeration date
06/02/2006
Last updated
02/26/2015
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