MEDICARE: ANTONIO LEE ANDERSON

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	171M00000X	Case Manager/Care Coordinator	03415076	TX

General Provider Information

NPI Number	:	1619839834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO LEE ANDERSON

Provider Business Mailing Address
First Line	:	11777 KATY FWY STE 230S
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-1773
Country	:	US
Telephone Number	:	713-429-5114
Fax Number	:

Provider Business Practice Location Address
First Line	:	11777 KATY FWY STE 230S
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-1773
Country	:	US
Telephone Number	:	713-429-5114
Fax Number	:

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

Provider Enumeration Date	:	11/25/2025
Last Update Date	:	11/25/2025

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Directions to “ ANTONIO LEE ANDERSON ” Practice Location

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