MEDICARE: MARITES Q ANSAY M.D.

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	207Q00000X	Family Medicine Physician	4301071277	MI
2	208000000X	Pediatrics Physician	4301071277	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	370013653	OTHER	RR CARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	34187400	OTHER	EDS
4	700C610000	OTHER	BCBS

General Provider Information

NPI Number	:	1609871904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARITES Q ANSAY M.D.

Provider Business Mailing Address
First Line	:	1400 W ICE LAKE RD
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-9526
Country	:	US
Telephone Number	:	906-265-6121
Fax Number	:	906-265-4245

Provider Business Practice Location Address
First Line	:	927 RIVERSIDE PLZ
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-1529
Country	:	US
Telephone Number	:	906-265-2165
Fax Number	:

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	09/09/2013

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Directions to “ MARITES Q ANSAY M.D.” Practice Location

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