Basic Information
Provider Information
NPI: 1326494907
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BELL
FirstName: ANITA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 804 SERVICE RD STE A109B
Address2:  
City: EAST LANSING
State: MI
PostalCode: 488247015
CountryCode: US
TelephoneNumber: 5173534911
FaxNumber: 5174323928
Practice Location
Address1: 1200 E MICHIGAN AVE
Address2: SUITE 520
City: LANSING
State: MI
PostalCode: 489121800
CountryCode: US
TelephoneNumber: 5173645356
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/12/2016
LastUpdateDate: 06/07/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/07/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208100000X5101022273MIY Allopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

No ID Information.


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