Individual
KIMBERLAND SHARESH ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7905 CALUMET AVE, MUNSTER, IN 46321-2549
(219) 836-3049
(219) 836-7295
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01073217A
IN
207Q00000X
Family Medicine Physician
036123265
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201193760
—
IN
01
—
553180
MEDICARE GROUP PTAN
IL
01
—
834340
MEDICARE GROUP PTAN
IL
Enumeration date
12/09/2008
Last updated
02/15/2023
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