Provider Demographics
NPI:1861455206
Name:REDENTE, ANTHONY L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:L
Last Name:REDENTE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7967 HALLIE DRIVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-7606
Mailing Address - Country:US
Mailing Address - Phone:734-482-4677
Mailing Address - Fax:
Practice Address - Street 1:7967 HALLIE DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-7606
Practice Address - Country:US
Practice Address - Phone:734-482-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002402363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical