Provider Demographics
NPI:1194087205
Name:ZANN, ANJA MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:ANJA
Middle Name:MICHELLE
Last Name:ZANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8404 INDIAN HILLS DRIVE
Mailing Address - Street 2:IHE 6TH FLOOR - UROLOGY
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2664
Mailing Address - Country:US
Mailing Address - Phone:024-955-4002
Mailing Address - Fax:
Practice Address - Street 1:8200 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4113
Practice Address - Country:US
Practice Address - Phone:402-955-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE334152088P0231X
FLTRN17316208800000X
OH35.130522208800000X
OH35-1305222088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0272962Medicaid
OHH543730OtherCGS-MEDICARE