Provider Demographics
NPI:1336883073
Name:ANTIPENKO, SERGEY VALERYEVICH (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SERGEY
Middle Name:VALERYEVICH
Last Name:ANTIPENKO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2181 MYRTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-5174
Mailing Address - Country:US
Mailing Address - Phone:334-467-7807
Mailing Address - Fax:
Practice Address - Street 1:300 MEADOWMONT VILLAGE CIR STE 202
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7518
Practice Address - Country:US
Practice Address - Phone:984-974-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program