Provider Demographics
NPI:1558330936
Name:ANDERSON, ILSE J (MD)
Entity Type:Individual
Prefix:
First Name:ILSE
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1924 ALCOA HWY
Mailing Address - Street 2:UT MEDICAL CENTER, MOB A, SUITE 435
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1511
Mailing Address - Country:US
Mailing Address - Phone:865-544-9030
Mailing Address - Fax:865-544-6675
Practice Address - Street 1:1924 ALCOA HWY
Practice Address - Street 2:UT MEDICAL CENTER, MOB A, SUITE 435
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:865-544-9030
Practice Address - Fax:865-544-6675
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2010-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000021338170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics