MEDICARE: MRS. CYNTHIA JEAN ANNESKI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	24757	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	387995	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1326001892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA JEAN ANNESKI MD

Provider Business Mailing Address
First Line	:	PO BOX 1731
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85299-1731
Country	:	US
Telephone Number	:	480-426-1566
Fax Number	:	480-275-3538

Provider Business Practice Location Address
First Line	:	1452 N HIGLEY RD STE 101
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-1610
Country	:	US
Telephone Number	:	480-426-1566
Fax Number	:	480-275-3538

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	04/20/2017

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