Provider Demographics
NPI:1841292372
Name:ANAR, MOMTAZ (MD)
Entity type:Individual
Prefix:
First Name:MOMTAZ
Middle Name:
Last Name:ANAR
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 1:28351 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6331
Mailing Address - Country:US
Mailing Address - Phone:586-393-6500
Mailing Address - Fax:586-393-6515
Practice Address - Street 1:28351 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6331
Practice Address - Country:US
Practice Address - Phone:586-393-6500
Practice Address - Fax:586-393-6515
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3177711Medicaid
MI3177711Medicaid
MIM75620049Medicare ID - Type Unspecified