Provider Demographics
NPI:1447200274
Name:ANDERSON, MILO VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:MILO
Middle Name:VICTOR
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:350 W 23RD ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2592
Mailing Address - Country:US
Mailing Address - Phone:402-721-8800
Mailing Address - Fax:402-753-6096
Practice Address - Street 1:350 W 23RD ST
Practice Address - Street 2:SUITE D
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2592
Practice Address - Country:US
Practice Address - Phone:402-721-8800
Practice Address - Fax:402-753-6096
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE15643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-065440900Medicaid
NE47-065440900Medicaid
NEB90817Medicare UPIN