Healthcare Provider Details

I. General information

NPI: 1205897998
Provider Name (Legal Business Name): ANITA S MACDONALD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANITA KRISTIN SCHWEICKART MD

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 UNIVERSITY AVE STE 160 MAIL STOP 13901B
SAINT PAUL MN
55114-1271
US

IV. Provider business mailing address

2635 UNIVERSITY AVE W STE 160
SAINT PAUL MN
55114-1270
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-3500
  • Fax: 651-254-3699
Mailing address:
  • Phone: 651-254-3500
  • Fax: 651-254-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45358
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: