Individual
ANTHONY PANICCIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19901 E 10 MILE RD, ST CLAIR SHORES, MI 48080-1069
(586) 777-1277
(586) 777-0106
Mailing address
43800 GARFIELD RD, SUITE 201, CLINTON TWP, MI 48038-1136
(800) 848-0202
(586) 226-6949
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301070278
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0501046
BCBS PIN
MI
01
—
0P27380
MEDICARE GROUP LEGACY #
MI
05
—
4588604
—
MI
Enumeration date
02/28/2006
Last updated
12/06/2007
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