MEDICARE: MR. KENT ERNEST ANDERSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	4301043128	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2002100152	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1083615041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENT ERNEST ANDERSON M.D.

Provider Business Mailing Address
First Line	:	128 S 25TH ST
Second Line	:
City	:	ESCANABA
State	:	MI
Zip	:	49829-1364
Country	:	US
Telephone Number	:	906-786-4100
Fax Number	:	906-786-3997

Provider Business Practice Location Address
First Line	:	128 S 25TH ST
Second Line	:
City	:	ESCANABA
State	:	MI
Zip	:	49829-1364
Country	:	US
Telephone Number	:	906-786-4100
Fax Number	:	906-786-3997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	05/06/2009

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