Healthcare Provider Details

I. General information

NPI: 1205800034
Provider Name (Legal Business Name): KENNETH C ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4003 KRESGE WAY STE 312
LOUISVILLE KY
40207
US

IV. Provider business mailing address

4003 KRESGE WAY STE 312
LOUISVILLE KY
40207-4652
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-7377
  • Fax: 502-899-1972
Mailing address:
  • Phone: 502-899-7377
  • Fax: 502-899-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25175
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25175
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number25175
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: