MEDICARE: KENT E. ANDERSON, M.D. P.C.

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	4301043128	MI

General Provider Information

NPI Number	:	1942431747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENT E. ANDERSON, M.D. P.C.

Provider Business Mailing Address
First Line	:	128 SOUTH 25TH STREET SUITE B
Second Line	:
City	:	ESCANABA
State	:	MI
Zip	:	49829
Country	:	US
Telephone Number	:	906-786-4100
Fax Number	:	906-786-3997

Provider Business Practice Location Address
First Line	:	128 S 25TH ST STE B
Second Line	:
City	:	ESCANABA
State	:	MI
Zip	:	49829-1364
Country	:	US
Telephone Number	:	906-786-4100
Fax Number	:	906-786-3997

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KENT ERNEST ANDERSON
Credential	:	MD
Telephone Number	:	906-786-4100

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	07/29/2009

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