Provider Demographics
NPI:1114904448
Name:HORSTMAN, ANNA M (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:HORSTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SOUTH BROAD ST
Mailing Address - Street 2:PO BOX 417
Mailing Address - City:KALIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45853
Mailing Address - Country:US
Mailing Address - Phone:419-532-3958
Mailing Address - Fax:419-532-2326
Practice Address - Street 1:109 SOUTH BROAD ST
Practice Address - Street 2:
Practice Address - City:KALIDA
Practice Address - State:OH
Practice Address - Zip Code:45853
Practice Address - Country:US
Practice Address - Phone:419-532-3958
Practice Address - Fax:419-532-2326
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH049354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0563322Medicaid
CA3755OtherRAILROAD MEDICARE
000000025708OtherANTHEM
000000025708OtherANTHEM
CA3755OtherRAILROAD MEDICARE