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General NPI Number Information
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NPI Number | 1043404924
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Entity Type | Individual
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Provider Name | ANASTASIA ELIZABETH BANICKI HOFFMAN MD
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Gender | Female
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 1343 ROCHESTER RD SUITE 104
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City | TROY
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State | MI
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Zip | 48083-6015
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Country | US
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Telephone | 248-918-4911
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Fax | 248-579-0076
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Provider Business Mailing Address
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Address Line | 1343 ROCHESTER RD SUITE 104
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City | TROY
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State | MI
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Zip | 48083-6015
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Country | US
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Telephone | 248-918-4911
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Fax | 248-579-0076
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301081387
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License Number State | MI
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