Individual
RURIC (ANDY) CLESBY ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1020 N 12TH ST, INTERNAL MEDICINE CLINIC AURORA HEALTH CARE, MILWAUKEE, WI 53233-1308
(414) 219-7887
(414) 219-7044
Mailing address
1020 N 12TH ST STE 5120, AURORA HEALTH CARE, MILWAUKEE, WI 53233-1308
(414) 219-7887
(414) 219-7044
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-093107
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093106
—
IL
01
—
P00337332
RAILROAD MEDICARE
IL
Enumeration date
12/06/2006
Last updated
01/25/2012
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