Healthcare Provider Details

I. General information

NPI: 1508862590
Provider Name (Legal Business Name): VICKI ANTON ANTHENS DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19723 ALLEN RD
BROWNSTOWN TWP MI
48183-1021
US

IV. Provider business mailing address

19723 ALLEN RD
BROWNSTOWN TWP MI
48183-1021
US

V. Phone/Fax

Practice location:
  • Phone: 734-479-8383
  • Fax: 734-479-8382
Mailing address:
  • Phone: 734-479-8383
  • Fax: 734-479-8382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. VICKI MARIA ANTONATHENS
Title or Position: PRESIDENT
Credential: DPM
Phone: 734-479-8383