Provider Demographics
NPI:1609869106
Name:CONNAGHAN, ANN S (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:S
Last Name:CONNAGHAN
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:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-797-1041
Mailing Address - Fax:989-799-0256
Practice Address - Street 1:5821 COLONY DR N
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638
Practice Address - Country:US
Practice Address - Phone:989-797-1041
Practice Address - Fax:989-799-0256
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAC043757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOZ91013OtherBLUE CROSS & BLUE SHIEL
MI3356140Medicaid
MIOM41310Medicare ID - Type Unspecified
MIA76231Medicare UPIN