Individual
MICHAEL ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11100 EUCLID AVENUE, CLEVELAND, OH 44106
(216) 844-1700
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
35-064699
OH
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
35064699
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221343
UNISON
OH
01
—
000000525873
ANTHEM
OH
01
—
0016456270001
PA MEDICAID
PA
01
—
0237578
BCMH
OH
05
—
0237578
—
OH
01
—
0659127
AETNA
OH
01
—
200206430A
OK MEDICAID
OK
01
—
363311
WELLCARE
OH
01
—
731836
BUCKEYE
OH
01
—
P00411231
RAILROAD MEDICARE
OH
05
—
Q64699
—
SC
Enumeration date
10/31/2005
Last updated
02/22/2011
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