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1407843683

NPI Code Detail

MEDICARE: DR. ANGELA K ANDERSON MD

MEDICARE: DR. ANGELA K ANDERSON 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	207V00000X	Obstetrics & Gynecology Physician	036094384	IL
2	207V00000X	Obstetrics & Gynecology Physician	61886	WI
3	207V00000X	Obstetrics & Gynecology Physician	9035	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00009296	OTHER	IL	MEDICARE RR
2	5236530001	OTHER	IL	MEDICARE DME ID

General Provider Information

NPI Number	:	1407843683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA K ANDERSON MD

Provider Business Mailing Address
First Line	:	PO BOX 6020
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57709-6020
Country	:	US
Telephone Number	:	605-342-3280
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 MOUNT RUSHMORE RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-5462
Country	:	US
Telephone Number	:	605-342-3280
Fax Number	:

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	04/19/2016

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Directions to “ DR. ANGELA K ANDERSON MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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