Individual
TRACI A ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
200 ENTERPRISE DR STE A, PENDLETON, IN 46064-9038
(765) 298-4567
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(765) 298-4569
(765) 298-4568
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02003246A
IN
207Q00000X
Family Medicine Physician
34008676
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000527527
ANTHEM
IN
01
—
P00474998
RAILROAD MEDICARE
—
01
—
P01018446
RR MEDICARE
IN
Enumeration date
06/16/2006
Last updated
10/09/2025
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