MEDICARE: KEVIN C ANDERSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	01079147A	IN
2	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	01079147A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427150796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN C ANDERSON MD

Provider Business Mailing Address
First Line	:	710 N NILES AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46617-1924
Country	:	US
Telephone Number	:	574-647-1610
Fax Number	:	574-237-6069

Provider Business Practice Location Address
First Line	:	100 NAVARRE PL STE 4440
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46601-1171
Country	:	US
Telephone Number	:	574-647-5300
Fax Number	:	574-647-5305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	12/30/2019

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Directions to “ KEVIN C ANDERSON MD” Practice Location

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