Provider Demographics
NPI:1316633415
Name:ANTOINE MEDICAL GROUP LLC
Entity type:Organization
Organization Name:ANTOINE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAKIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTOINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:337-739-2801
Mailing Address - Street 1:613 INEZ RD
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-7017
Mailing Address - Country:US
Mailing Address - Phone:337-739-2801
Mailing Address - Fax:
Practice Address - Street 1:650 POYDRAS ST STE 1400
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-6116
Practice Address - Country:US
Practice Address - Phone:248-877-1036
Practice Address - Fax:630-358-6764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty