Provider Demographics
NPI:1588893283
Name:DUDLEY, ANNE (DO)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5515 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-9670
Mailing Address - Country:US
Mailing Address - Phone:269-429-6604
Mailing Address - Fax:269-429-1715
Practice Address - Street 1:5515 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9670
Practice Address - Country:US
Practice Address - Phone:269-429-6604
Practice Address - Fax:269-429-1715
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101018463208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1588893283Medicaid
MIMI2051198Medicare PIN