MEDICARE: MR. TORSTEN WAINO ANDERSEN MD

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	208000000X	Pediatrics Physician	ME21596	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	201376	OTHER		AVMED
2	01988	OTHER		BCBS

General Provider Information

NPI Number	:	1356300669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TORSTEN WAINO ANDERSEN MD

Provider Business Mailing Address
First Line	:	149 NE 241ST ST
Second Line	:
City	:	CROSS CITY
State	:	FL
Zip	:	32628-5844
Country	:	US
Telephone Number	:	352-498-1360
Fax Number	:	352-498-1363

Provider Business Practice Location Address
First Line	:	149 NE 241ST ST
Second Line	:	DIXIE COUNTY HEALTH DEPARTMENT
City	:	CROSS CITY
State	:	FL
Zip	:	32628-5844
Country	:	US
Telephone Number	:	352-498-1360
Fax Number	:	352-498-1363

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/08/2007

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