Provider Demographics
NPI:1336349547
Name:HSU, ANTHONY TRIVINO (DO)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:TRIVINO
Last Name:HSU
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:26850 PROVIDENCE PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1259
Mailing Address - Country:US
Mailing Address - Phone:248-697-2822
Mailing Address - Fax:888-443-3187
Practice Address - Street 1:26850 PROVIDENCE PKWY STE 360
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1261
Practice Address - Country:US
Practice Address - Phone:248-697-2822
Practice Address - Fax:888-443-3187
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2023-10-19
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Provider Licenses
StateLicense IDTaxonomies
MI5101017422207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1336349547Medicaid
MI200000033173OtherPHYSICIANS HEALTH PLAN
MI200000033173OtherPHYSICIANS HEALTH PLAN