Provider Demographics
NPI:1205903325
Name:JOANNIDESCARBAJO, ANNE M (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:JOANNIDESCARBAJO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1080 KIRTS BLVD
Mailing Address - Street 2:SUITE# 400
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4881
Mailing Address - Country:US
Mailing Address - Phone:248-362-2660
Mailing Address - Fax:248-362-0662
Practice Address - Street 1:1080 KIRTS BLVD
Practice Address - Street 2:SUITE# 400
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4881
Practice Address - Country:US
Practice Address - Phone:248-362-2660
Practice Address - Fax:248-362-0662
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
MI43010656362080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301065636OtherSTATE LIC. #
MI4301065636OtherSTATE LIC. #