Provider Demographics
NPI:1568460244
Name:ANDERSON, KURT M (MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:M
Last Name:ANDERSON
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 1:123 E 3RD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2937
Mailing Address - Country:US
Mailing Address - Phone:641-684-0044
Mailing Address - Fax:641-684-9015
Practice Address - Street 1:123 E 3RD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2937
Practice Address - Country:US
Practice Address - Phone:641-684-0044
Practice Address - Fax:641-684-9015
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25465174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0258459Medicaid
IAA03574Medicare UPIN
IA0258459Medicaid