Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 12-00407 | KS |
N | 222Z00000X | Podiatrist | 12-00407 | KS |
Y | 213ES0103X | Foot & Ankle Surgery | 2012024470 | MO |
NPI | 1043565922 |
---|---|
Provider Name | Michael Andersen |
First Address | Lees Summit, MO 64086-4937 |
Second Address | Kansas City, MO 64139-1236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2012 |
Last Update Date | 09/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201116690A | (05) | KS |