Provider Demographics
NPI:1265538441
Name:SEXTON-ANDERSON, TONYA A (DO)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:A
Last Name:SEXTON-ANDERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR STE J2000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:
Practice Address - Street 1:202 W HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1162
Practice Address - Country:US
Practice Address - Phone:517-234-6540
Practice Address - Fax:517-338-9083
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0853303224OtherBCBSM PIN
MI438846111Medicaid
MI0853303224OtherBCBSM PIN
MI0N47520Medicare ID - Type Unspecified