Annette L Aquino, D.O.
Individual provider Active NPI General Practice Physician · Eastpointe, MI
NPI 1922094341 · NPPES record last updated Dec 12, 2013
Key facts
- NPI
- 1922094341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- AS014643 (MI)
- Practice address
- 24901 Kelly Rd
Eastpointe, MI 48021-1384 - Phone
- (586) 772-9055
- Fax
- (586) 772-0543
- NPI assigned
- Sep 21, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AS014643 | MI | MD | General Practice Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | AS014643 | MI | Yes |
Addresses
Primary practice location
24901 Kelly Rd
Eastpointe, MI 48021-1384
Mailing address
24901 Kelly Rd
Eastpointe, MI 48021-1384
Phone (586) 772-9055
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922094341 | Medicaid | MI | |
| 383397259 | Other | MI | TAX INDENTIFICATION |
Other providers in Eastpointe, MI
- Angelic Touch Services LLC
- Ankle & Foot Clinic PC
- Annie Bell Chambers Home Help Care LLC
- Annie Bell Chambers Multi Service Center
- Sharalynn Cathleen Apice
- Demetria Archie
- Aria Rose Home Care
- Lisa Armstrong
- Patricia Ann Arnold
- Sharie Yuvette Arthur-Jones
All providers in Eastpointe, MI · General Practice Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 12, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.