Provider Demographics
NPI:1811957756
Name:D'ERRICO, ANTHONY J (DO)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:D'ERRICO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1701 SOUTH BLVD E
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6122
Mailing Address - Country:US
Mailing Address - Phone:248-997-9000
Mailing Address - Fax:248-997-9007
Practice Address - Street 1:3577 W 13 MILE RD
Practice Address - Street 2:SUITE 404
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-551-6900
Practice Address - Fax:248-551-6909
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006815207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI113526536Medicaid
MIE33138Medicare UPIN
MI113526536Medicaid