Healthcare Provider Details

I. General information

NPI: 1861685950
Provider Name (Legal Business Name): ANNIE CACY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27351 DEQUINDRE RD
MADISON HEIGHTS MI
48071-3487
US

IV. Provider business mailing address

3401 W GORE BLVD
LAWTON OK
73505-6332
US

V. Phone/Fax

Practice location:
  • Phone: 248-967-7795
  • Fax: 248-967-7794
Mailing address:
  • Phone: 580-535-8620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5216
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5216
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: