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General NPI Number Information
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NPI Number | 1255405296
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Entity Type | Organization
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Legal Business Name | DR. ANNETTE C. LACASSE, D.O., P.C.
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 04/11/2008
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Provider Practice Location Address
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Address Line | 8906 COMMERCE RD STE 5
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City | COMMERCE TWP
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State | MI
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Zip | 48382-4484
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Country | US
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Telephone | 248-363-5555
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Fax | 248-363-5519
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Provider Business Mailing Address
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Address Line | 8906 COMMERCE RD STE 5
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City | COMMERCE TWP
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State | MI
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Zip | 48382-4484
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Country | US
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Telephone | 248-363-5555
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Fax | 248-363-5519
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KATHY A PROST
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Credential |
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Telephone | 248-363-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | AL007602
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License Number State | MI
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