Provider Demographics
NPI:1033109368
Name:ANDERSON, NILS (MD)
Entity Type:Individual
Prefix:DR
First Name:NILS
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:DEPT OF SPECIALTY MEDICINE, NAVAL HEALTH CLINIC
Mailing Address - Street 2:3001A SIXTH ST, BLDG 200H
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088
Mailing Address - Country:US
Mailing Address - Phone:847-688-3444
Mailing Address - Fax:847-688-4487
Practice Address - Street 1:3001A 6TH ST
Practice Address - Street 2:DEPT OF SPECIALTY MEDICINE, NAVAL HEALTH CLINIC
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-2811
Practice Address - Country:US
Practice Address - Phone:847-688-3444
Practice Address - Fax:847-688-4487
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-1080382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology