Provider Demographics
NPI:1114239670
Name:ANDERSONNING, THERESA R (DO)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:R
Last Name:ANDERSONNING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:R
Other - Last Name:DUNNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21345 CASS ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-5223
Mailing Address - Country:US
Mailing Address - Phone:248-924-4884
Mailing Address - Fax:
Practice Address - Street 1:28050 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5919
Practice Address - Country:US
Practice Address - Phone:248-471-8822
Practice Address - Fax:248-471-8837
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1828737204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM