Provider Demographics
NPI:1043404924
Name:BANICKI HOFFMAN, ANASTASIA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANASTASIA
Middle Name:ELIZABETH
Last Name:BANICKI HOFFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1343 ROCHESTER RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6015
Mailing Address - Country:US
Mailing Address - Phone:248-918-4911
Mailing Address - Fax:248-579-0076
Practice Address - Street 1:1343 ROCHESTER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-6015
Practice Address - Country:US
Practice Address - Phone:248-918-4911
Practice Address - Fax:248-579-0076
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010813872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry