Provider Demographics
NPI:1174513279
Name:LACASSE, ANNETTE C (DO)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:C
Last Name:LACASSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8906 COMMERCE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4484
Mailing Address - Country:US
Mailing Address - Phone:248-363-5555
Mailing Address - Fax:248-363-5519
Practice Address - Street 1:8906 COMMERCE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-4484
Practice Address - Country:US
Practice Address - Phone:248-363-5555
Practice Address - Fax:248-363-5519
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2008-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIAL007602207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5630162Medicare ID - Type Unspecified
E25504Medicare UPIN