Individual
ANTIOAN KARDOUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1145 RESERVOIR AVE, SUITE 301, CRANSTON, RI 02920-6055
(401) 946-5001
(401) 946-5101
Mailing address
1145 RESERVOIR AVE, SUITE 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
—
2847513
AETNA
—
01
—
408195
BLUE CHIP
RI
05
—
AK35758
—
RI
01
—
P00083165
RAILROAD MEDICARE
—
Enumeration date
11/28/2005
Last updated
07/08/2007
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