Provider Demographics
NPI:1922025907
Name:GABA, ANU G (MD)
Entity Type:Individual
Prefix:
First Name:ANU
Middle Name:G
Last Name:GABA
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 1:820 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58122-0001
Mailing Address - Country:US
Mailing Address - Phone:701-234-6161
Mailing Address - Fax:701-234-7257
Practice Address - Street 1:820 4TH ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58122-0001
Practice Address - Country:US
Practice Address - Phone:701-234-6161
Practice Address - Fax:701-234-7257
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9598207RH0003X
MN47654207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN567465400Medicaid
820S4GAOtherMN BCBS
HP42398OtherHEALTHPARTNERS
1041215OtherPREFERREDONE
ND13055Medicaid
24359OtherNDBCBS
3600498OtherMEDICA
SD7714340Medicaid
I04003Medicare UPIN
1041215OtherPREFERREDONE