Individual
KATHLEEN C ANTOLAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6051
(541) 382-2811
Mailing address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6051
(541) 382-2811
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD23421
OR
207Q00000X
Family Medicine Physician
Primary
MD23421
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00479094
RAILROAD
OR
05
—
287220
—
OR
Enumeration date
06/28/2006
Last updated
01/29/2021
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