Provider Demographics
NPI:1013022193
Name:WILBORN, ANITA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:MICHELLE
Last Name:WILBORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1717 N FLAGLER DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6555
Mailing Address - Country:US
Mailing Address - Phone:561-655-9417
Mailing Address - Fax:
Practice Address - Street 1:1717 N FLAGLER DR
Practice Address - Street 2:SUITE 3
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-6555
Practice Address - Country:US
Practice Address - Phone:561-655-9417
Practice Address - Fax:561-655-9804
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072607207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
43840OtherBLUE CROSS BLUE SHEILD
110229649OtherMEDICARE RAILROAD
7106633001OtherCIGNA
FL110229649Medicaid
2173611OtherAETNA
37030OtherNEIGHBORHOOD HEALTH
2173611OtherAETNA
FL110229649Medicaid
FLG79333Medicare UPIN