Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01079147A | IN |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 01079147A | IN |
NPI | 1427150796 |
---|---|
Provider Name | Kevin C Anderson |
First Address | South Bend, IN 46617-1924 |
Second Address | South Bend, IN 46601-1171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 30/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300006370 | (05) | IN |