Provider Demographics
NPI:1497783278
Name:FUNKE, ANDERSON B (MD)
Entity Type:Individual
Prefix:
First Name:ANDERSON
Middle Name:B
Last Name:FUNKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 VENTURE CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-8558
Mailing Address - Country:US
Mailing Address - Phone:864-725-5594
Mailing Address - Fax:864-725-5598
Practice Address - Street 1:116 VENTURE CT
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-8558
Practice Address - Country:US
Practice Address - Phone:864-725-5594
Practice Address - Fax:864-725-5598
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLL7507Medicaid
SCE344318536Medicare PIN
SC8536Medicare PIN
E34431Medicare UPIN
SCLL7507Medicaid