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General NPI Number Information
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NPI Number | 1386310472
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Entity Type | Individual
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Provider Name | MATTHEW DAVID ANDERSON MD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 4700 S CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60632-2016
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Country | US
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Telephone | 773-584-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 800 STANTON L YOUNG BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5018
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Country | US
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Telephone | 405-271-2316
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 125.085952
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License Number State | IL
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