Provider Demographics
NPI:1275527327
Name:FEMMININEO, ANTHONY F (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:F
Last Name:FEMMININEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8301 RELIABLE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0083
Mailing Address - Country:US
Mailing Address - Phone:586-498-2400
Mailing Address - Fax:586-498-2800
Practice Address - Street 1:25311 LITTLE MACK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3370
Practice Address - Country:US
Practice Address - Phone:586-498-2400
Practice Address - Fax:586-498-2800
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301405128208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1275527327Medicaid
A79546Medicare UPIN
MI102846165Medicaid
MI4301405128OtherMICHIGAN LICENSE