Healthcare Provider Details

I. General information

NPI: 1790901429
Provider Name (Legal Business Name): KAI ANDERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 HALLMARK CT
SAGINAW MI
48603-2109
US

IV. Provider business mailing address

1000 HOUGHTON AVE
SAGINAW MI
48602
US

V. Phone/Fax

Practice location:
  • Phone: 989-790-5990
  • Fax:
Mailing address:
  • Phone: 989-746-7500
  • Fax: 989-746-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number4301052423
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: