Individual
IAN P ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
825 BARRET AVE, LOUISVILLE, KY 40204-1743
(502) 540-7200
(502) 540-7210
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 272-5395
(502) 272-5339
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
TP861
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000718931
ANTHEM - NCMA
KY
01
—
000057120R
HUMANA - NCMA
KY
01
—
126735
SIHO - NCMA
KY
01
—
201033230
MEDICAID - NCMA
IN
01
—
50033806
PASSPORT - NCMA
KY
05
—
7100164430
—
IN
05
—
7100164430
—
KY
Enumeration date
06/06/2008
Last updated
09/17/2021
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