Evangeline A Ancheta, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

EA037604 Issued in MI

Practice address

609 Quarter St
Gladwin, MI 48624-1941

Phone

(989) 246-6371

Fax

(989) 246-6330

NPI assigned

Jul 13, 2006

Last updated

Sep 7, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346976000000",
    "number": "1841215423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 QUARTER ST",
            "city": "GLADWIN",
            "state": "MI",
            "postal_code": "486241941",
            "telephone_number": "989-246-6371",
            "fax_number": "989-246-6330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 QUARTER ST",
            "city": "GLADWIN",
            "state": "MI",
            "postal_code": "486241941",
            "telephone_number": "989-246-6371",
            "fax_number": "989-246-6330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANCHETA",
        "first_name": "EVANGELINE",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2012-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "EA037604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - PIN",
            "identifier": "0802610352",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4251887",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3374210",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Accuquest Hearing Center, LLC
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• Deborah Faye Aldrich
• Corey Lee Allen, DDS
• Rylie Alward, PA
• Atrium Gladwin LLC (Gladwin Nursing and Rehabilitation Community)
• Kelly Jo Avila
• Beau Richard Bailer
• Annette Bailey
• Jacob Bailey

• Family Medicine Physician in Gladwin, MI
• Providers in Gladwin, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.