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General NPI Number Information
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NPI Number | 1225455991
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Entity Type | Organization
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Legal Business Name | ANDERSON SPORTS MEDICINE
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 32270 TELEGRAPH RD STE 220B
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City | BINGHAM FARMS
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State | MI
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Zip | 48025-2456
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Country | US
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Telephone | 248-480-9080
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Fax | 248-480-9081
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Provider Business Mailing Address
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Address Line | 32270 TELEGRAPH RD STE 220B
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City | BINGHAM FARMS
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State | MI
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Zip | 48025-2456
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Country | US
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Telephone | 248-480-9080
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Fax | 248-480-9081
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Authorized Official
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Title or Position | OWNER
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Name | KYLE ANDERSON
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Credential | M.D.
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Telephone | 248-663-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 4301074015
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License Number State | MI
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