Individual
TYNESE SIMONE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1021 W 5TH AVE, GARY, IN 46402-1703
(219) 880-1190
(219) 378-7147
Mailing address
1021 W 5TH AVE, GARY, IN 46402-1703
(219) 880-1190
(219) 378-7147
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01084389A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300042215
INDIANA LPI
IN
Enumeration date
05/08/2012
Last updated
01/29/2021
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