Individual
TOMMI ANDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 ARCADE AVE STE 230, ELKHART, IN 46514-2485
(574) 522-6565
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-6592
(574) 647-1821
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004195A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300084536
—
IN
Enumeration date
07/06/2023
Last updated
12/20/2023
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