Provider Demographics
NPI:1326819574
Name:ANDERSON PODIATRY PC
Entity Type:Organization
Organization Name:ANDERSON PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RHODONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PODIATRIST
Authorized Official - Phone:248-227-1736
Mailing Address - Street 1:2829 RAMBLING WAY
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1046
Mailing Address - Country:US
Mailing Address - Phone:248-227-1736
Mailing Address - Fax:
Practice Address - Street 1:30301 WOODWARD AVE STE 120
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0981
Practice Address - Country:US
Practice Address - Phone:248-435-6622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty