Healthcare Provider Details

I. General information

NPI: 1689253155
Provider Name (Legal Business Name): ANNA FALCONBURG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA STYRCZULA

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W MAIN ST
FREMONT MI
49412-1181
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 231-924-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301511373
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: