Provider Demographics
NPI:1851361885
Name:ANDERSON, CANDICE SUE (MD)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:SUE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 BURR RIDGE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0833
Mailing Address - Country:US
Mailing Address - Phone:630-756-5270
Mailing Address - Fax:
Practice Address - Street 1:1333 BURR RIDGE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527
Practice Address - Country:US
Practice Address - Phone:630-756-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040540A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00307969OtherRAILROAD MEDICARE
IN000000387969OtherBLUE CROSS / BLUE SHIELD
IN100200110OtherMEDICAID
IN000000556516OtherBLUE CROSS / BLUE SHIELD
IN01064540AOtherMEDICAL LICENSE
IN000000387969OtherBLUE CROSS / BLUE SHIELD
IN233350BMedicare ID - Type Unspecified
INF42675Medicare UPIN