Individual
MARTIN JULIUS ANDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1115 RONALD REAGAN PKWY STE 206, AVON, IN 46123-6911
(317) 217-2200
(317) 217-2205
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
02003131A
IN
207RN0300X
Nephrology Physician
Primary
02003131A
IN
207RN0300X
Nephrology Physician
200600754
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000509680
ANTHEM PTAN
IN
01
—
200600754
N.C, MEDICAL BOARD
NC
05
—
200843770
—
IN
Enumeration date
07/10/2006
Last updated
03/05/2025
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