Provider Demographics
NPI:1619054111
Name:NORTH, ANITA GAIL (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:GAIL
Last Name:NORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:601 MULHOLLAND ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-4208
Practice Address - Country:US
Practice Address - Phone:989-894-5533
Practice Address - Fax:989-864-7161
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301087084207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1022507OtherMCLAREN HEALTH PLAN
MI1022768OtherMCLAREN HEALTH PLAN
MI1022769OtherMCLAREN HEALTH PLAN
MI4957806Medicaid
MI7002946010OtherBCBS
MI1022507OtherMCLAREN HEALTH PLAN
MI1022768OtherMCLAREN HEALTH PLAN