Healthcare Provider Details

I. General information

NPI: 1033537345
Provider Name (Legal Business Name): ANYA V MENZIES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANYA KUTSENOK

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11050 PARKVIEW CIRCLE DR
FORT WAYNE IN
46845-1739
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 833-724-8326
  • Fax: 260-266-8941
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number294451-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2020-00177
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number01090860A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: