Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 5101019507 | MI |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 61418 | MN |
NPI | 1437446887 |
---|---|
Provider Name | Dr. Michael Richard Anderson |
First Address | Woodbury, MN 55125-2522 |
Second Address | Woodbury, MN 55125-2522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2011 |
Last Update Date | 01/08/2017 |