Provider Demographics
NPI:1194779843
Name:ANDERS, CARL B (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:B
Last Name:ANDERS
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 1:224 CIRCLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2700
Mailing Address - Country:US
Mailing Address - Phone:231-932-4903
Mailing Address - Fax:231-935-0613
Practice Address - Street 1:224 CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2700
Practice Address - Country:US
Practice Address - Phone:231-932-4903
Practice Address - Fax:231-935-0613
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103465341Medicaid
MI3465341Medicaid
MIOM85930027Medicare PIN
MI0M59170Medicare UPIN
MIE35041Medicare UPIN
MI103465341Medicaid