Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | L1828737 | MI |
Y | 207Q00000X | Family Doctor | L1828737 | MI |
NPI | 1114239670 |
---|---|
Provider Name | Theresa R Andersonning |
First Address | Farmington Hills, MI 48335-5223 |
Second Address | Farmington Hills, MI 48336-5919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2010 |
Last Update Date | 12/07/2010 |