Individual
KATHERINE D ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
701 N 1ST ST, SPRINGFIELD, IL 62781-0001
(217) 788-3156
Mailing address
DEPT 960347, OKLAHOMA CITY, OK 73196-0347
(877) 485-4474
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036123933
IL
207P00000X
Emergency Medicine Physician
125.052986
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036123933
—
IL
Enumeration date
07/11/2007
Last updated
11/15/2011
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