Individual
KEVIN M ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
610 W ADAMS ST, BLACK RIVER FALLS, WI 54615-9010
(715) 284-4311
(715) 284-2568
Mailing address
610 W ADAMS ST, BLACK RIVER FALLS, WI 54615-9010
(715) 284-4311
(715) 284-2568
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
47711
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34646600
—
WI
Enumeration date
07/19/2006
Last updated
06/30/2025
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