Provider Demographics
NPI:1326083700
Name:JONASCU-DEVINE, ANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:JONASCU-DEVINE
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 1:8901 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-5119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11700 METRO AIRPORT CENTER DR
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-1456
Practice Address - Country:US
Practice Address - Phone:734-955-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI059584207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAJ059584OtherBLUE SHIELD
MI104335280Medicaid
MI104166964Medicaid
MI104166964Medicaid
MIMI1503Medicare PIN
MIMI1503027Medicare UPIN
MIM60650151Medicare ID - Type Unspecified
MIMI1504027Medicare UPIN
MIMI1504Medicare PIN