Provider Demographics
NPI:1407986201
Name:ANDERSON, RHODONNA MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:RHODONNA
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 RAMBLING WAY
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1046
Mailing Address - Country:US
Mailing Address - Phone:248-338-1130
Mailing Address - Fax:
Practice Address - Street 1:30301 WOODWARD AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0979
Practice Address - Country:US
Practice Address - Phone:248-435-6622
Practice Address - Fax:248-435-7453
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001673213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI070F373320OtherBCBS
MI7123738OtherAETNA
MIU44808Medicare UPIN