Individual
KIESHA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
6913 N MAIN ST STE 100, GRANGER, IN 46530-8039
(574) 647-8542
(574) 647-8542
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-3725
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
02006115A
IN
2084N0600X
Clinical Neurophysiology Physician
Primary
02006115A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201374980
—
IN
Enumeration date
06/22/2016
Last updated
12/18/2024
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