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Individual

KEITH RICHARD ANDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
11040 N STATE ROAD 77, HAYWARD, WI 54843-3606
(715) 934-4321
Mailing address
11040 N STATE ROAD 77, HAYWARD, WI 54843-3606
(715) 934-4321

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
1017-25
WI
213E00000X
Podiatrist
850
MN
213EP1101X
Primary Podiatric Medicine Podiatrist
1017-25
WI
213EP1101X
Primary Podiatric Medicine Podiatrist
850
MN
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
1017-25
WI
213ES0103X
Foot & Ankle Surgery Podiatrist
850
MN

Other

Enumeration date
08/08/2011
Last updated
05/18/2021
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