Individual
ANTHONY JAMES COLUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
15855 NINETEEN MILE ROAD, EMERGENCY MEDICINE DEPARTMENT, CLINTON TWP, MI 48038-3504
(586) 263-2601
(586) 263-2589
Mailing address
28935 ANN ARBOR ROAD, CREDENTIALING/PAYOR CONTRACTING SERVICES, LIVONIA, MI 48150-3397
(734) 632-0175
(734) 632-0182
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101010623
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11273954
CAQH
—
05
—
1477523520
—
MI
Enumeration date
01/23/2006
Last updated
04/26/2012
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