Anna Maria Cantu
Individual provider Active NPI Driver · Grand Rapids, MI
NPI 1922855261 · NPPES record last updated May 3, 2024
Key facts
- NPI
- 1922855261
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- C530067585577 (MI)
- Practice address
- 1018 Dorchester Ave SW
Grand Rapids, MI 49503-4808 - Phone
- (616) 427-8382
- NPI assigned
- May 3, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C530067585577 | MI | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver |
172A00000X | C530067585577 | MI | Yes |
Addresses
Primary practice location
1018 Dorchester Ave SW
Grand Rapids, MI 49503-4808
Mailing address
1018 Dorchester Ave SW
Grand Rapids, MI 49503-4808
Phone (616) 427-8382
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5611451 | Medicaid | MI |
Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.