Healthcare Provider Details

I. General information

NPI: 1245791268
Provider Name (Legal Business Name): ANNE GLADDING DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

IV. Provider business mailing address

999 N 92ND ST STE 730
MILWAUKEE WI
53226-4875
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number5101028866
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: