=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407986201
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RHODONNA MARIE ANDERSON D.P.M.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 11/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30301 WOODWARD AVE SUITE 120
-----------------------------------------------------
City | ROYAL OAK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48073-0979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-435-6622
-----------------------------------------------------
Fax | 248-435-7453
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2829 RAMBLING WAY
-----------------------------------------------------
City | BLOOMFIELD HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48302-1046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-338-1130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 5901001673
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------