Healthcare Provider Details

I. General information

NPI: 1881721165
Provider Name (Legal Business Name): PREMCHAND ANNE M.D., M.B.A., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22201 MOROSS RD PB II, SUITE 275
DETROIT MI
48236-2169
US

IV. Provider business mailing address

22201 MOROSS RD STE 275
DETROIT MI
48236-2176
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-4887
  • Fax: 313-343-6822
Mailing address:
  • Phone: 313-343-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301080539
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number4301080539
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301080539
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: