Provider Demographics
NPI:1770673436
Name:DIMICK, ANASTASIA PETRO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANASTASIA
Middle Name:PETRO
Last Name:DIMICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2433 OAK VALLEY DR.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103
Mailing Address - Country:US
Mailing Address - Phone:734-474-0200
Mailing Address - Fax:734-474-0199
Practice Address - Street 1:2433 OAK VALLEY DR.
Practice Address - Street 2:STE. 400
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103
Practice Address - Country:US
Practice Address - Phone:734-474-0200
Practice Address - Fax:734-474-0199
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301075791207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH86442Medicare ID - Type Unspecified