Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 41087 | CO |
N | 207P00000X | Emergency Physician | 4301095514 | MI |
NPI | 1003805268 |
---|---|
Provider Name | Dr. Adam Michael Anderson |
First Address | Grand Rapids, MI 49501-3578 |
Second Address | Grand Rapids, MI 49503-4502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 19/09/2016 |