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1588862114

NPI Code Detail

MEDICARE: DR. COREY D ANDERSON MD

MEDICARE: DR. COREY D 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	207L00000X	Anesthesiology Physician	0101260667	VA
2	207L00000X	Anesthesiology Physician	ME109122	FL
3	207L00000X	Anesthesiology Physician	U4391	TX
4	207L00000X	Anesthesiology Physician	3049-320	WI
5	207L00000X	Anesthesiology Physician	35.098567	OH
6	207L00000X	Anesthesiology Physician	C192246	CA
7	207L00000X	Anesthesiology Physician	2024049040	MO
8	207L00000X	Anesthesiology Physician	R8025	IA
9	207L00000X	Anesthesiology Physician	MD217005	OR
10	207L00000X	Anesthesiology Physician	01076345A	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
2	ME109122	OTHER	FL	FL STATE LICENSE
3	35.098567	OTHER	OH	OH STATE LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588862114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COREY D ANDERSON MD

Provider Business Mailing Address
First Line	:	PO BOX 78106
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1008
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	1701 S CREASY LN
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-4972
Country	:	US
Telephone Number	:	765-502-4917
Fax Number	:	765-502-4023

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

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	05/22/2026

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Directions to “ DR. COREY D ANDERSON MD” Practice Location

Language	Start Address	Practice Location

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