Provider Demographics
NPI:1366525842
Name:WATSON, ANNA K (PA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:K
Last Name:WATSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 MACKINTOSH LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0933
Mailing Address - Country:US
Mailing Address - Phone:313-743-8086
Mailing Address - Fax:
Practice Address - Street 1:2770 MACKINTOSH LN
Practice Address - Street 2:B1 FLOOR UNIVERSITY HOSPITAL RECP EMERGENCY
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0933
Practice Address - Country:US
Practice Address - Phone:313-743-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54840363A00000X
MI5601002980363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1158113040OtherBCBS IND
MIMI3292021Medicare PIN
MIP77342Medicare UPIN