Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 S 25TH ST STE B
ESCANABA MI
49829-1364
US

IV. Provider business mailing address

128 SOUTH 25TH STREET SUITE B
ESCANABA MI
49829
US

V. Phone/Fax

Practice location:
  • Phone: 906-786-4100
  • Fax: 906-786-3997
Mailing address:
  • Phone: 906-786-4100
  • Fax: 906-786-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301043128
License Number StateMI

VIII. Authorized Official

Name: MR. KENT ERNEST ANDERSON
Title or Position: PRESIDENT
Credential: MD
Phone: 906-786-4100