Provider Demographics
NPI:1205897998
Name:MACDONALD, ANITA S (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:S
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:KRISTIN
Other - Last Name:SCHWEICKART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2635 UNIVERSITY AVE W
Mailing Address - Street 2:STE 160
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1270
Mailing Address - Country:US
Mailing Address - Phone:651-254-3500
Mailing Address - Fax:651-254-3699
Practice Address - Street 1:2635 UNIVERSITY AVE STE 160
Practice Address - Street 2:MAIL STOP 13901B
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1271
Practice Address - Country:US
Practice Address - Phone:651-254-3500
Practice Address - Fax:651-254-3699
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H19550Medicare UPIN