Provider Demographics
NPI:1730136672
Name:ANDERSON, ADINA-MARIA (DPM)
Entity Type:Individual
Prefix:
First Name:ADINA-MARIA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-0549
Mailing Address - Country:US
Mailing Address - Phone:906-774-1313
Mailing Address - Fax:906-776-5639
Practice Address - Street 1:225 W H ST
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4608
Practice Address - Country:US
Practice Address - Phone:906-776-5940
Practice Address - Fax:906-779-2586
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002125213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43241400Medicaid
MI5220021OtherBCBS OF MI
MI4881074Medicaid
MIP00958672OtherRR MEDICARE
MI4881074Medicaid
MI5220021OtherBCBS OF MI
WI43241400Medicaid