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General NPI Number Information
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NPI Number | 1396967550
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Entity Type | Organization
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Legal Business Name | JOEL R. ANDERSON, PC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 4920 N CENTRAL AVE STE 1A
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City | CHICAGO
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State | IL
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Zip | 60630-2338
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Country | US
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Telephone | 773-736-3338
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Fax | 773-736-1289
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Provider Business Mailing Address
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Address Line | 4920 N CENTRAL AVE SUITE 1A
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City | CHICAGO
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State | IL
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Zip | 60630-2338
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Country | US
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Telephone | 773-736-3338
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Fax | 773-736-1289
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOEL R ANDERSON
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Credential | D.P.M.
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Telephone | 773-736-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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