Healthcare Provider Details

I. General information

NPI: 1144658253
Provider Name (Legal Business Name): MICHAEL ALLEN ANDERSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E 10TH ST
ATLANTIC IA
50022-1936
US

IV. Provider business mailing address

1501 E 10TH ST
ATLANTIC IA
50022-1936
US

V. Phone/Fax

Practice location:
  • Phone: 712-243-3250
  • Fax:
Mailing address:
  • Phone: 712-243-3250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA063449
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60419014
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: