Healthcare Provider Details

I. General information

NPI: 1538160510
Provider Name (Legal Business Name): ANNE MARIE ROMANIK-PATENAUDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26850 PROVIDENCE PKWY SUITE 455
NOVI MI
48374-1213
US

IV. Provider business mailing address

15990 W 9 MILE RD
SOUTHFIELD MI
48075-4826
US

V. Phone/Fax

Practice location:
  • Phone: 248-465-4847
  • Fax: 248-465-4877
Mailing address:
  • Phone: 248-849-4226
  • Fax: 248-849-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301065549
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: