Provider Demographics
NPI:1467245621
Name:PATHAK, ANNA DOROTA (DO, PHD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:DOROTA
Last Name:PATHAK
Suffix:
Gender:F
Credentials:DO, PHD
Other - Prefix:
Other - First Name:ANIA
Other - Middle Name:DOROTA
Other - Last Name:PATHAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO, PHD
Mailing Address - Street 1:4660 S HAGADORN RD STE 500
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6804
Mailing Address - Country:US
Mailing Address - Phone:517-432-6144
Mailing Address - Fax:
Practice Address - Street 1:4660 S HAGADORN RD STE 500
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6804
Practice Address - Country:US
Practice Address - Phone:517-432-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program