Provider Demographics
NPI:1366000895
Name:MIRACLE, ANNA (DO)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MIRACLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3884 MONITOR RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9298
Mailing Address - Country:US
Mailing Address - Phone:989-671-2000
Mailing Address - Fax:
Practice Address - Street 1:3884 MONITOR RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9298
Practice Address - Country:US
Practice Address - Phone:989-671-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151013787207Q00000X
MI5101026834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine