Antolak, Kathleen C
Antolak, Kathleen C is an individual health care provider with primary practice located at 1501 Ne Medical Center Dr , Bend OR 97701-6051. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Other Service Providers / Specialist. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Antolak, Kathleen C can be contacted via phone (541) 382-2811.Contact Information
Primary practice address
1501 Ne Medical Center Dr
Bend OR 97701-6051
Phone: (541) 382-2811
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | MD23421 | Oregon |
| Other Service Providers / Specialist | 174400000X | MD23421 | Oregon |
Profile Details
| NPI number | 1316975741 |
|---|---|
| LBN Legal business name | Antolak, Kathleen C |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 28th, 2006 |
| Last updated | Jan 29th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316975741 | NPPES |
| Oregon | MEDICAID | 287220 | |
| Oregon | Other | 00479094 |
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