Provider Demographics
NPI:1740222447
Name:DRELICHMAN, ANIBAL (MD)
Entity Type:Individual
Prefix:
First Name:ANIBAL
Middle Name:
Last Name:DRELICHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22301 FOSTER WINTER DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3707
Mailing Address - Country:US
Mailing Address - Phone:248-552-0620
Mailing Address - Fax:248-552-0286
Practice Address - Street 1:22301 FOSTER WINTER DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3707
Practice Address - Country:US
Practice Address - Phone:248-552-0620
Practice Address - Fax:248-552-0286
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAD036112207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M75300008Medicare ID - Type Unspecified
MIB45839Medicare UPIN