Basic Information
| Provider Information | |||||||||
| NPI: | 1922094341 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AQUINO | ||||||||
| FirstName: | ANNETTE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24901 KELLY RD | ||||||||
| Address2: | |||||||||
| City: | EASTPOINTE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480211384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867729055 | ||||||||
| FaxNumber: | 5867720543 | ||||||||
| Practice Location | |||||||||
| Address1: | 24901 KELLY RD | ||||||||
| Address2: | |||||||||
| City: | EASTPOINTE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480211384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867729055 | ||||||||
| FaxNumber: | 5867720543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 12/12/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | AS014643 | MI | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 1922094341 | 05 | MI | MEDICAID | 383397259 | 01 | MI | TAX INDENTIFICATION | OTHER |