Individual
DR. JOHN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2507 N RICHMOND RD, MCHENRY, IL 60051
(815) 338-6600
(815) 344-8957
Mailing address
2507 N RICHMOND RD, MCHENRY, IL 60051-5407
(815) 338-6600
(815) 344-8957
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036103841
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-103841
STATE LICENSE NUMBER
IL
01
—
P00015719
MEDICARE RAILROAD CARRIER
IL
Enumeration date
05/04/2006
Last updated
10/19/2018
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