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NPI Code Detail

MEDICARE: MICHAEL ANDERSON

MEDICARE: MICHAEL ANDERSON
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1417636747
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL ANDERSON
Provider Business Mailing Address
First Line : 250 UTICA AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11213-3931
Country : US
Telephone Number : 347-201-1844
Fax Number :
Provider Business Practice Location Address
First Line : 250 UTICA AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11213-3931
Country : US
Telephone Number : 347-201-1844
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2023
Last Update Date : 11/12/2024

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