Individual
ANTENEH M ADDISU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 SW ARCHER RD, BOX 100277, GAINESVILLE, FL 32610-3003
(352) 265-0651
Mailing address
1600 SW ARCHER RD, BOX 100277, GAINESVILLE, FL 32610-3003
(352) 265-0651
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME75316
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
254252800
—
FL
01
—
593534735
TAX ID
FL
Enumeration date
05/20/2006
Last updated
09/24/2015
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