Individual
ANTILISHIA O'BANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRANIAL PROSTHESIS
Contact information
Practice address
25140 LAHSER RD STE 212, SOUTHFIELD, MI 48033-6200
(313) 452-2662
Mailing address
25140 LAHSER RD STE 212, SOUTHFIELD, MI 48033-6200
(313) 452-2662
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
01/17/2024
Last updated
01/17/2024
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