Individual
DR. PAMELA MARIE ANTONIUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3000 32ND AVE S, FARGO, ND 58103-6132
(701) 364-8000
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-8000
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
11656
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366513970
—
MN
05
—
15402
—
ND
05
—
9020306
—
RI
Enumeration date
11/13/2006
Last updated
12/24/2015
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