Provider Demographics
NPI:1093763153
Name:DOBRACKI, ANNA TERESA (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:TERESA
Last Name:DOBRACKI
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8546 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2326
Mailing Address - Country:US
Mailing Address - Phone:810-227-0906
Mailing Address - Fax:810-227-6511
Practice Address - Street 1:8546 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2326
Practice Address - Country:US
Practice Address - Phone:810-227-0906
Practice Address - Fax:810-227-6511
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060576207KA0200X
MI430106056207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1093763153Medicaid
MI0M72610Medicare PIN