Provider Demographics
NPI:1801669841
Name:ANTEM, KEVIN ACHUO
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ACHUO
Last Name:ANTEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13006 OLD STAGE COACH RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1628
Mailing Address - Country:US
Mailing Address - Phone:240-716-8084
Mailing Address - Fax:
Practice Address - Street 1:13006 OLD STAGE COACH RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1628
Practice Address - Country:US
Practice Address - Phone:240-716-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker