MEDICARE: VICKI ANTON ANTHENS DPM PC

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	213E00000X	Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480H278050	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1508862590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICKI ANTON ANTHENS DPM PC

Provider Business Mailing Address
First Line	:	19723 ALLEN RD
Second Line	:
City	:	BROWNSTOWN TWP
State	:	MI
Zip	:	48183-1021
Country	:	US
Telephone Number	:	734-479-8383
Fax Number	:	734-479-8382

Provider Business Practice Location Address
First Line	:	19723 ALLEN RD
Second Line	:
City	:	BROWNSTOWN TWP
State	:	MI
Zip	:	48183-1021
Country	:	US
Telephone Number	:	734-479-8383
Fax Number	:	734-479-8382

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. VICKI MARIA ANTONATHENS
Credential	:	DPM
Telephone Number	:	734-479-8383

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/22/2008

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