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NPI Code Detail

MEDICARE: ELISE ANDERSON MD

MEDICARE: ELISE 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
12084P0800XPsychiatry Physician4351048618MI
22084P0800XPsychiatry Physician4301513790MI

General Provider Information

NPI Number : 1619544491
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISE ANDERSON MD
Provider Business Mailing Address
First Line : 300 68TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49548-6927
Country : US
Telephone Number : 616-559-5870
Fax Number :
Provider Business Practice Location Address
First Line : 300 68TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49548-6927
Country : US
Telephone Number : 616-559-5870
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2021
Last Update Date : 01/23/2026

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Directions to “ ELISE ANDERSON MD” Practice Location

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