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NPI Code Detail

MEDICARE: ALISSA ANASTASIO DO

MEDICARE: ALISSA ANASTASIO DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program5151016065MI

General Provider Information

NPI Number : 1063104834
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALISSA ANASTASIO DO
Provider Business Mailing Address
First Line : 1522 SIMPSON RD EAST
Second Line : MPB D3230
City : ANN ARBOR
State : MI
Zip : 48109
Country : US
Telephone Number : 734-647-1774
Fax Number :
Provider Business Practice Location Address
First Line : 1051 N CANTON CENTER RD
Second Line :
City : CANTON
State : MI
Zip : 48187-5097
Country : US
Telephone Number : 734-844-5400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2023
Last Update Date : 02/02/2026

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Directions to “ ALISSA ANASTASIO DO” Practice Location

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