MEDICARE: KENT 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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1730610585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENT ANDERSON

Provider Business Mailing Address
First Line	:	280 VIEW DR
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2343
Country	:	US
Telephone Number	:	866-290-5049
Fax Number	:	888-744-3731

Provider Business Practice Location Address
First Line	:	280 VIEW DR
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2343
Country	:	US
Telephone Number	:	866-290-5049
Fax Number	:	888-744-3731

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

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	03/23/2017

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Directions to “ KENT ANDERSON ” Practice Location

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