Provider Demographics
NPI:1891971628
Name:CRUZ, JEANETTE ANUDDIN (MD)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:ANUDDIN
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 LARCH DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1889
Mailing Address - Country:US
Mailing Address - Phone:480-789-0814
Mailing Address - Fax:480-789-0814
Practice Address - Street 1:16928 W BELL RD STE 701
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8948
Practice Address - Country:US
Practice Address - Phone:623-850-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ81714207Q00000X
MI4301095410207Q00000X
AZ42393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301095410OtherPHYSICIAN LICENSE
AZ491303Medicaid
AZ81714OtherTRANING PERMIT
AZ42393OtherPHYSICIAN LICENSE
AZ42393OtherPHYSICIAN LICENSE