Individual
ANTHONY VINCENT FASANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13101 ALLEN RD, SOUTHGATE, MI 48195-2216
(734) 785-7700
Mailing address
1685 WINCHESTER AVE, LINCOLN PARK, MI 48146-3844
(313) 784-4437
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
MI
Other
Enumeration date
11/20/2023
Last updated
11/20/2023
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