Provider Demographics
NPI:1114283678
Name:AXELSON, ANNA ROGERS (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ROGERS
Last Name:AXELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 W GRAND BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3141
Mailing Address - Country:US
Mailing Address - Phone:313-916-2171
Mailing Address - Fax:313-916-2093
Practice Address - Street 1:3031 W GRAND BLVD STE 800
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3141
Practice Address - Country:US
Practice Address - Phone:313-916-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.128759207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program