Provider Demographics
NPI:1871685008
Name:ANDERSEN, MICHAEL DEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEE
Last Name:ANDERSEN
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 1:24619 WASHINGTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8228
Mailing Address - Country:US
Mailing Address - Phone:951-894-7555
Mailing Address - Fax:951-894-7575
Practice Address - Street 1:24619 WASHINGTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8228
Practice Address - Country:US
Practice Address - Phone:951-316-7132
Practice Address - Fax:951-894-7575
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG083821207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G83821Medicare ID - Type Unspecified
CAG61332Medicare UPIN