Provider Demographics
NPI:1942265145
Name:IBELE, ANNA R (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:R
Last Name:IBELE
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:DEPARTMENT OF SURGERY
Mailing Address - Street 2:30 NORTH 1900 EAST
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-587-3856
Mailing Address - Fax:801-587-9370
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:UNIVERSITY OF UTAH HEALTH CARE-SURGERY
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-587-3856
Practice Address - Fax:801-587-9370
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI965-TEP208600000X
UT9068926-8905208600000X
WI50432390200000X
UT9068926-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program