MEDICARE: DR. ANNA TERESA DOBRACKI MD PHD

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
1	207KA0200X	Allergy Physician	4301060576	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093763153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA TERESA DOBRACKI MD PHD

Provider Business Mailing Address
First Line	:	8546 W GRAND RIVER AVE
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-2326
Country	:	US
Telephone Number	:	810-227-0906
Fax Number	:	810-227-6511

Provider Business Practice Location Address
First Line	:	8546 W GRAND RIVER AVE
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-2326
Country	:	US
Telephone Number	:	810-227-0906
Fax Number	:	810-227-6511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	06/22/2021

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