| Id Micro Pllc | |
|
130 W Ravine Rd Kingsport TN 37660-3837 | |
| (423) 915-1126 | |
| Not Available |
| Full Name | Id Micro Pllc |
|---|---|
| Speciality | Internal Medicine - Infectious Disease |
| Location | 130 W Ravine Rd, Kingsport, Tennessee |
| Authorized Official Name and Position | Anton Maki (OWNER) |
| Authorized Official Contact | 4239151126 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Id Micro Pllc 130 W Ravine Rd Kingsport TN 37660-3837 Ph: (423) 915-1126 | Id Micro Pllc 130 W Ravine Rd Kingsport TN 37660-3837 Ph: (423) 915-1126 |
| NPI Number | 1477598076 |
|---|---|
| Provider Enumeration Date | 06/18/2006 |
| Last Update Date | 01/24/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477598076 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | MD38189 (Tennessee) | Primary |
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