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General NPI Number Information
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NPI Number | 1245377837
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Entity Type | Individual
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Provider Name | JOHN KENNETH ANDERSON MD
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 2305 GENOA BUSINESS PARK DR STE 120
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City | BRIGHTON
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State | MI
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Zip | 48114-7004
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Country | US
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Telephone | 810-494-6881
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Fax | 810-494-6882
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DR LBBY J2000
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City | ANN ARBOR
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State | MI
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Zip | 48105-9484
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 061034
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 4301061034
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License Number State | MI
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