Individual
TODD W ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3050 MONTVALE DR STE A, SPRINGFIELD, IL 62704-6924
(217) 726-8096
Mailing address
2040 W ILES AVE, SUITE C, SPRINGFIELD, IL 62704-4183
(217) 789-0668
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036105321
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105321
—
IL
Enumeration date
06/08/2006
Last updated
08/03/2015
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