Provider Demographics
NPI:1427020908
Name:ANASON, KATHRYN L (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:ANASON
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 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:722 LOCUST ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2040
Practice Address - Country:US
Practice Address - Phone:231-592-4200
Practice Address - Fax:231-527-6859
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047870207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E4451Medicare PIN
A76771Medicare UPIN
MI3259450Medicaid