Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 38189 | TN |
N | 111NI0900X | Internist | 38189 | TN |
N | 207RI0200X | Infectious Disease | 101241430 | VA |
N | 207RI0200X | Infectious Disease | 35224 | KY |
N | 207RI0200X | Infectious Disease | 36220 | GA |
N | 207RI0200X | Infectious Disease | 4301054714-2728243 | MI |
Y | 207RI0200X | Infectious Disease | MD38189 | TN |
N | 207RI0200X | Infectious Disease | ME-112221 | FL |
NPI | 1053355602 |
---|---|
Provider Name | Dr. Anton Maki JR. |
First Address | Kingsport, TN 37663-2823 |
Second Address | Kingsport, TN 37663-2823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 22/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010035830 | (05) | VA |
3723199 | (05) | TN |
4002772 | MEDICARE - BCBS ADMINISTERED (01) | TN |
F52974 | (02) |