Individual
DR. RICHARD ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 MAIN STREET, 3RD FLOOR, PEORIA, IL 61606-2037
(309) 495-0200
(309) 676-6545
Mailing address
1001 MAIN STREET, 3RD FLOOR, PEORIA, IL 61606-2037
(309) 495-0200
(309) 676-6545
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036095602
IL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
036095602
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020046522
RR MEDICARE
IL
05
—
036095602-1
—
IL
01
—
7215166
BLUE CROSS BLUE SHIELD
IL
Enumeration date
06/28/2006
Last updated
01/09/2025
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