Provider Demographics
NPI:1922094341
Name:AQUINO, ANNETTE L (DO)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:L
Last Name:AQUINO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24901 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1384
Mailing Address - Country:US
Mailing Address - Phone:586-772-9055
Mailing Address - Fax:586-772-0543
Practice Address - Street 1:24901 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1384
Practice Address - Country:US
Practice Address - Phone:586-772-9055
Practice Address - Fax:586-772-0543
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS014643208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1922094341Medicaid
MI383397259OtherTAX INDENTIFICATION
MI383397259OtherTAX INDENTIFICATION
MIMI4989050Medicare PIN