Healthcare Provider Details

I. General information

NPI: 1720015571
Provider Name (Legal Business Name): ANITA KAYE BUBLIK-ANDERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 PLAZA DR SUITE 2100
WAUSAU WI
54401-4158
US

IV. Provider business mailing address

2720 PLAZA DR SUITE 2100
WAUSAU WI
54401-4158
US

V. Phone/Fax

Practice location:
  • Phone: 715-847-2475
  • Fax: 715-843-1482
Mailing address:
  • Phone: 715-847-2475
  • Fax: 715-843-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number53016-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: