Provider Demographics
NPI:1922272392
Name:ANNAN, ABIGAIL AMY (MD)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:AMY
Last Name:ANNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ABIGAIL
Other - Middle Name:AMY
Other - Last Name:OLLENNU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:117 W PATERSON ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-2557
Mailing Address - Country:US
Mailing Address - Phone:269-349-2641
Mailing Address - Fax:269-201-2855
Practice Address - Street 1:117 W PATERSON ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-2557
Practice Address - Country:US
Practice Address - Phone:269-349-2641
Practice Address - Fax:269-201-2855
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X207Q00000X
IN01071550A207Q00000X, 207V00000X
MI4301108581207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1922272392Medicaid
IN201138000Medicaid