Provider Demographics
NPI:1972591857
Name:CORTESE, ANTOINETTE ANN (MD)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:ANN
Last Name:CORTESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-4624
Mailing Address - Country:US
Mailing Address - Phone:775-883-1700
Mailing Address - Fax:775-883-8905
Practice Address - Street 1:1400 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4624
Practice Address - Country:US
Practice Address - Phone:775-883-1700
Practice Address - Fax:775-883-8905
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV93472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016816Medicaid
CA1972591857Medicaid
NV002016816Medicaid