Provider Demographics
NPI:1083004881
Name:ZIRKEL, ANNE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:ZIRKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 W KEECH AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5537
Mailing Address - Country:US
Mailing Address - Phone:734-735-5522
Mailing Address - Fax:
Practice Address - Street 1:518 W KEECH AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5537
Practice Address - Country:US
Practice Address - Phone:734-735-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08740392Medicaid