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Individual

KYLE ANDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
32270 TELEGRAPH RD STE 220B, BINGHAM FARMS, MI 48025-2456
(248) 480-9080
(248) 480-9081
Mailing address
32270 TELEGRAPH RD STE 220, BINGHAM FARMS, MI 48025-2405
(248) 480-9080

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
4301074015
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0767220001
ADMINISTAR FEDERAL
MI
01
0F31114
BCBS
MI
01
0F33583
BCBS DME
MI
05
411776310
MI
01
700H262250
BLUE CROSS-BLUE CROSS
01
KA074015
CHAMPUS-CHAMPUS
Enumeration date
11/15/2005
Last updated
10/14/2019
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