Provider Demographics
NPI:1073000691
Name:EMANUEL, ANNA I (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:I
Last Name:EMANUEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:I
Other - Last Name:WIJATYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:740 S PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4717
Mailing Address - Country:US
Mailing Address - Phone:310-563-7366
Mailing Address - Fax:
Practice Address - Street 1:740 S PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4717
Practice Address - Country:US
Practice Address - Phone:310-563-7366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0207Q00000X
WI75127207Q00000X
CAA176896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine