Provider Demographics
NPI:1295704815
Name:LAFOND, ANN AMMOND (MD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:AMMOND
Last Name:LAFOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8584 N CANTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1310
Mailing Address - Country:US
Mailing Address - Phone:734-455-4917
Mailing Address - Fax:
Practice Address - Street 1:8584 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1310
Practice Address - Country:US
Practice Address - Phone:734-455-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL043764207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI64889BOtherHEALTH ALLIANCE PLAN
MI3899973001OtherCIGNA
MI102494OtherCARE CHOICES
MI4139614OtherAETNA
MIC2791OtherMCARE
MI3899973001OtherCIGNA
MI0Q26487Medicare ID - Type Unspecified