Provider Demographics
NPI:1417954611
Name:ANANIA, MICHELLE (DPM)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ANANIA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-502-3511
Practice Address - Street 1:1450 S CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4085
Practice Address - Country:US
Practice Address - Phone:330-270-2700
Practice Address - Fax:330-792-2110
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-3092-A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2104003-000Medicaid
OH2250782Medicaid
OH4050258Medicare ID - Type Unspecified
OH4050253Medicare ID - Type Unspecified
OH4050283Medicare ID - Type Unspecified
OH4050251Medicare ID - Type Unspecified
OH4050254Medicare ID - Type Unspecified
OH4050281Medicare ID - Type Unspecified
OH4050284Medicare ID - Type Unspecified
OH4050257Medicare ID - Type Unspecified
OH4050286Medicare ID - Type Unspecified
OH2250782Medicaid
WV2104003-000Medicaid
OH4050252Medicare ID - Type Unspecified
OH4050259Medicare ID - Type Unspecified
OH4050282Medicare ID - Type Unspecified
OH4050287Medicare ID - Type Unspecified
OH4050256Medicare ID - Type Unspecified
OH4050285Medicare ID - Type Unspecified