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NPI Code Detail

MEDICARE: TRACI A ANDERSON D.O.

MEDICARE: TRACI A ANDERSON D.O.
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
1207Q00000XFamily Medicine Physician02003246AIN
2207Q00000XFamily Medicine Physician34008676OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00474998OTHERRAILROAD MEDICARE
2P01018446OTHERINRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3000000527527OTHERINANTHEM

General Provider Information

NPI Number : 1619911757
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACI A ANDERSON D.O.
Provider Business Mailing Address
First Line : 6626 E 75TH ST STE 500
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-2890
Country : US
Telephone Number : 765-298-4569
Fax Number : 765-298-4568
Provider Business Practice Location Address
First Line : 200 ENTERPRISE DR STE A
Second Line :
City : PENDLETON
State : IN
Zip : 46064-9038
Country : US
Telephone Number : 765-298-4567
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2006
Last Update Date : 10/09/2025

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Directions to “ TRACI A ANDERSON D.O.” Practice Location

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