Individual
KENNETH M ANDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5615 NW 86TH ST, JOHNSTON, IA 50131-1738
(515) 643-6000
(515) 643-6001
Mailing address
PO BOX 1475, DES MOINES, IA 50305-1475
(515) 643-6000
(515) 643-6001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24339
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3020362
—
IA
Enumeration date
08/08/2006
Last updated
01/21/2024
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