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Organization
ANNE-MARE ICE MD PC
Active
Organization
ANNE-MARE ICE MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KASSANDRA A HILL (GENERAL MANAGER)
(313) 255-4672
Entity
Organization
Contact information
Practice address
22341 W 8 MILE RD, DETROIT, MI 48219-1217
(313) 255-2209
Mailing address
22341 W 8 MILE RD, DETROIT, MI 48219-1217
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
4301031683
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H27243
BCBS OF MICHIGAN
MI
05
—
1066910
—
MI
Enumeration date
02/13/2008
Last updated
02/13/2008
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