Provider Demographics
NPI:1629064183
Name:NACHAZEL, ANNE M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:M
Last Name:NACHAZEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNE
Other - Middle Name:M
Other - Last Name:TOAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:25511 LITTLE MACK AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3372
Mailing Address - Country:US
Mailing Address - Phone:586-774-2020
Mailing Address - Fax:586-774-3169
Practice Address - Street 1:25511 LITTLE MACK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3372
Practice Address - Country:US
Practice Address - Phone:586-774-2020
Practice Address - Fax:586-774-3169
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301404848207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1805012611OtherBCBS OF MICHIGAN
1805012611OtherBCBS OF MICHIGAN
MIB43637Medicare UPIN