Provider Demographics
NPI:1295296945
Name:ANTIC, IZABELA (DO)
Entity type:Individual
Prefix:
First Name:IZABELA
Middle Name:
Last Name:ANTIC
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 HOUNDSTOOTH GLN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1301
Mailing Address - Country:US
Mailing Address - Phone:859-608-7036
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE STE D200
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-1760
Practice Address - Country:US
Practice Address - Phone:859-323-6700
Practice Address - Fax:859-257-1331
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY05874207RR0500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program