Healthcare Provider Details

I. General information

NPI: 1114051646
Provider Name (Legal Business Name): ANK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 MONROE ST STE 102
DEARBORN MI
48124-2938
US

IV. Provider business mailing address

2012 MONROE ST STE 102
DEARBORN MI
48124-2938
US

V. Phone/Fax

Practice location:
  • Phone: 313-565-3365
  • Fax: 313-565-3440
Mailing address:
  • Phone: 313-565-3365
  • Fax: 313-565-3440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number4301060472
License Number StateMI

VIII. Authorized Official

Name: MRS. MICHELLE R SHERRY
Title or Position: OFFICE MANAGER
Credential:
Phone: 313-565-3365