Healthcare Provider Details

I. General information

NPI: 1033735709
Provider Name (Legal Business Name): ANNA MARIE TOBIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA MARIE PLUMLEY PA-C

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 WATER TOWER PL STE 200
CLARKSTON MI
48346-2674
US

IV. Provider business mailing address

5625 WATER TOWER PL STE 200
CLARKSTON MI
48346-2674
US

V. Phone/Fax

Practice location:
  • Phone: 248-625-2621
  • Fax: 248-625-2622
Mailing address:
  • Phone: 248-625-2621
  • Fax: 248-625-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601009999
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: