Provider Demographics
NPI:1184683674
Name:WOODWARD, ANN M (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:WOODWARD
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 1:2799 WEST GRAND BLVD
Mailing Address - Street 2:CFP-123
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-916-6374
Mailing Address - Fax:313-916-5811
Practice Address - Street 1:2799 WEST GRAND BLVD
Practice Address - Street 2:CFP-123
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-916-6374
Practice Address - Fax:313-916-5811
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301074366208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ948284Medicaid
Z104288Medicare PIN
AZ948284Medicaid
H57800Medicare UPIN
Z120077Medicare PIN