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: | |
Other - Suffix: | |
Other - Last Name Type: | |
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: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 4301074366 | 208600000X, 2086S0102X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2086S0102X | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | 948284 | Medicaid | |
Z104288 | Medicare PIN | ||
AZ | 948284 | Medicaid | |
H57800 | Medicare UPIN | ||
Z120077 | Medicare PIN |