Healthcare Provider Details

I. General information

NPI: 1528770070
Provider Name (Legal Business Name): ANNA C THEECK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 FARMINGTON RD STE 105
LIVONIA MI
48154-5434
US

IV. Provider business mailing address

14700 FARMINGTON RD STE 105
LIVONIA MI
48154-5434
US

V. Phone/Fax

Practice location:
  • Phone: 248-330-7098
  • Fax:
Mailing address:
  • Phone: 248-330-7098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601012345
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: