Individual
MRS. KATHLEEN ANZICEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
12337 E MICHIGAN AVE, GRASS LAKE, MI 49240-0246
(517) 522-8403
(517) 522-4275
Mailing address
PO BOX 246, GRASS LAKE, MI 49240-0246
(517) 522-8403
(517) 522-4275
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
KA008052
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0153800065
BLUE CROSS BLUE SHIELD
MI
01
—
0153800065
BLUE CHOICE
—
01
—
015380065
BCBS FEP PROGRAM
—
05
—
2126487
—
MI
Enumeration date
09/26/2006
Last updated
05/06/2019
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