MEDICARE: ANDERSON ONCOLOGIC SERVICES LLC

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	2086X0206X	Surgical Oncology Physician

General Provider Information

NPI Number	:	1558991109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON ONCOLOGIC SERVICES LLC

Provider Business Mailing Address
First Line	:	11921 ORCHARD AVE W
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55305-2938
Country	:	US
Telephone Number	:	126-868-1806
Fax Number	:

Provider Business Practice Location Address
First Line	:	7450 FRANCE AVE S STE 220
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-4792
Country	:	US
Telephone Number	:	952-925-1111
Fax Number	:	952-922-3446

Authorized Official
Title or Position	:	SURGICAL ONCOLOGIS
Name	:	DR. CASANDRA ANN ANDERSON
Credential	:	MD
Telephone Number	:	612-868-1806

Provider Enumeration Date	:	01/23/2020
Last Update Date	:	01/23/2020

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