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Individual

KEVIN C ANDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
100 NAVARRE PL STE 4440, SOUTH BEND, IN 46601-1171
(574) 647-5300
(574) 647-5305
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
01079147A
IN
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
Primary
01079147A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300006370
IN
Enumeration date
09/05/2006
Last updated
12/30/2019
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