Healthcare Provider Details

I. General information

NPI: 1033244843
Provider Name (Legal Business Name): DANIEL ANTONY ING MA,LLP,CCHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 E ELLSWORTH RD
ANN ARBOR MI
48108-2552
US

IV. Provider business mailing address

110 N 4TH AVE SUITE 102
ANN ARBOR MI
48104-5503
US

V. Phone/Fax

Practice location:
  • Phone: 734-222-3581
  • Fax: 734-971-2487
Mailing address:
  • Phone: 734-222-3581
  • Fax: 734-971-2487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361003168
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: