Individual
JOHN G ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1111 LEFFINGWELL AVE NE, STE 100, GRAND RAPIDS, MI 49525
(616) 459-7101
(616) 464-6170
Mailing address
1111 LEFFINGWELL AVE NE, STE 100, GRAND RAPIDS, MI 49525
(616) 459-7101
(616) 464-6170
Taxonomy
Speciality
Code
Description
License number
State
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
Primary
4301070607
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200030127
RAILROAD MEDICARE
—
05
—
3380119
—
MI
01
—
442790001
ADMINISTAR
—
Enumeration date
10/10/2005
Last updated
01/30/2013
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