Provider Demographics
NPI:1760496889
Name:ANNICH, GAIL M (MD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:ANNICH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:1500 EAST MEDICAL CENTER DR
Practice Address - Street 2:12TH FLOOR C.S MOTT CHILDRENS HOSPITAL RM 525
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-4280
Practice Address - Country:US
Practice Address - Phone:734-763-5302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301069635208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3400187Medicaid
G56826Medicare UPIN
MIOH16103217Medicare ID - Type Unspecified