Provider Demographics
NPI:1538273222
Name:MISSAVAGE, ANNE EVELYN (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:EVELYN
Last Name:MISSAVAGE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:4641 E PICKARD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2007
Mailing Address - Country:US
Mailing Address - Phone:989-956-3118
Mailing Address - Fax:989-956-3119
Practice Address - Street 1:4641 E PICKARD ST
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2007
Practice Address - Country:US
Practice Address - Phone:989-956-3118
Practice Address - Fax:989-956-3119
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2015-11-11
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Provider Licenses
StateLicense IDTaxonomies
MI4301043832208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1538273222Medicaid
MI1538273222Medicaid
MI0C36084027Medicare PIN