Healthcare Provider Details

I. General information

NPI: 1467499616
Provider Name (Legal Business Name): MICHELLE A ANDERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MICHELLE A KURLAWALLA

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E CITRUS AVE SUITE A
REDLANDS CA
92374-4270
US

IV. Provider business mailing address

PO BOX 2200
REDLANDS CA
92373-0722
US

V. Phone/Fax

Practice location:
  • Phone: 909-794-3682
  • Fax: 909-796-4158
Mailing address:
  • Phone: 909-793-3311
  • Fax: 909-796-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA83504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: