Provider Demographics
NPI:1255405296
Name:DR. ANNETTE C. LACASSE, D.O., P.C.
Entity type:Organization
Organization Name:DR. ANNETTE C. LACASSE, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PROST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-363-5555
Mailing Address - Street 1:8906 COMMERCE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4484
Mailing Address - Country:US
Mailing Address - Phone:248-363-5555
Mailing Address - Fax:248-363-5519
Practice Address - Street 1:8906 COMMERCE RD STE 5
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-4484
Practice Address - Country:US
Practice Address - Phone:248-363-5555
Practice Address - Fax:248-363-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL007602207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI207N00000XOtherTAXONOMY
MI207N00000XOtherTAXONOMY
MIE25504Medicare UPIN