Individual
KEVIN MICHAEL ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4 OKATIE CTR BLVD, OKATIE, SC 29909-7529
(843) 706-3206
Mailing address
4 OKATIE CTR BLVD, OKATIE, SC 29909-7529
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
82114
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/16/2012
Last updated
08/20/2019
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