Provider Demographics
NPI:1629146154
Name:ANDERSON, JOSEPH M (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3577 W 13 MILE RD
Mailing Address - Street 2:STE 404
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6710
Mailing Address - Country:US
Mailing Address - Phone:248-551-6900
Mailing Address - Fax:248-551-6909
Practice Address - Street 1:3577 W 13 MILE RD
Practice Address - Street 2:STE 404
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-551-6900
Practice Address - Fax:248-551-6909
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2013-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301048427207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI189979010Medicaid
MI189979010Medicaid
MIF37131024Medicare PIN