Healthcare Provider Details

I. General information

NPI: 1033226816
Provider Name (Legal Business Name): ANNA MARIE SANTILLAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 13 MILE RD
MADISON HEIGHTS MI
48071-1844
US

IV. Provider business mailing address

38487 W 10 MILE RD
FARMINGTON HILLS MI
48335-2809
US

V. Phone/Fax

Practice location:
  • Phone: 248-577-3659
  • Fax: 248-588-9320
Mailing address:
  • Phone: 248-477-9300
  • Fax: 248-477-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003165
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: