Healthcare Provider Details

I. General information

NPI: 1003819897
Provider Name (Legal Business Name): ANTHONY A EMMER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26400 W 12 MILE RD STE 170
SOUTHFIELD MI
48034-1753
US

IV. Provider business mailing address

26400 W 12 MILE RD STE 170
SOUTHFIELD MI
48034-1753
US

V. Phone/Fax

Practice location:
  • Phone: 248-208-8787
  • Fax: 248-208-8788
Mailing address:
  • Phone: 248-208-8787
  • Fax: 248-208-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number5101011705
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: