Healthcare Provider Details

I. General information

NPI: 1780195172
Provider Name (Legal Business Name): ANGELA LYNN PITTMAN C-AA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 N MAIN ST
LAPEER MI
48446-1350
US

IV. Provider business mailing address

3355 GLENDALE AVE FL 3
TOLEDO OH
43614-2426
US

V. Phone/Fax

Practice location:
  • Phone: 810-667-5500
  • Fax:
Mailing address:
  • Phone: 419-383-3556
  • Fax: 419-383-3550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number67.000311
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number0022405557
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: