MEDICARE: DR. ANNA V KULCZYCKI-MITTAG 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	207R00000X	Internal Medicine Physician	4301067684	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110F324370	OTHER	MI	BCBSM
2	DR500669	OTHER	MI	MCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801886049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA V KULCZYCKI-MITTAG MD

Provider Business Mailing Address
First Line	:	1701 SOUTH BLVD E
Second Line	:	STE 290
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6122
Country	:	US
Telephone Number	:	248-997-7900
Fax Number	:	248-997-7918

Provider Business Practice Location Address
First Line	:	1701 SOUTH BLVD E
Second Line	:	STE 290
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6122
Country	:	US
Telephone Number	:	248-997-7900
Fax Number	:	248-997-7918

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	05/10/2012

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