Healthcare Provider Details

I. General information

NPI: 1407843683
Provider Name (Legal Business Name): ANGELA K ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 MOUNT RUSHMORE RD
RAPID CITY SD
57701-5462
US

IV. Provider business mailing address

PO BOX 6020
RAPID CITY SD
57709-6020
US

V. Phone/Fax

Practice location:
  • Phone: 605-342-3280
  • Fax:
Mailing address:
  • Phone: 605-342-3280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036094384
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number61886
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number9035
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: