Healthcare Provider Details

I. General information

NPI: 1457673881
Provider Name (Legal Business Name): ANNE EVELYN MISSAVAGE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 PATIENT CARE WAY STE A
LANSING MI
48911-4271
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 517-374-7600
  • Fax: 517-374-9042
Mailing address:
  • Phone: 517-676-9788
  • Fax: 517-676-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301043832
License Number StateMI

VIII. Authorized Official

Name: ANNE E MISSAVAGE
Title or Position: OWNER
Credential: MD
Phone: 517-381-1321