Basic Information
| Provider Information | |||||||||
| NPI: | 1619054111 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORTH | ||||||||
| FirstName: | ANITA | ||||||||
| MiddleName: | GAIL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 MULHOLLAND ST | ||||||||
| Address2: | |||||||||
| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487084208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898945533 | ||||||||
| FaxNumber: | 9898647161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 4301087084 | MI | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1022507 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 1022768 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 1022769 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 4957806 | 05 | MI | MEDICAID | 7002946010 | 01 | MI | BCBS | OTHER |