Provider Demographics
NPI:1427121284
Name:ANDERSON, CRAIG B (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:B
Last Name:ANDERSON
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 1:7373 FRANCE AVENUE S
Mailing Address - Street 2:STE 302
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4538
Mailing Address - Country:US
Mailing Address - Phone:952-896-3166
Mailing Address - Fax:952-896-9853
Practice Address - Street 1:7373 FRANCE AVENUE S
Practice Address - Street 2:STE 302
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4538
Practice Address - Country:US
Practice Address - Phone:952-896-3166
Practice Address - Fax:952-896-9853
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31433207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP12793OtherHEALTHPARTNERS
XX1410822004OtherPREFERRED ONE
1022621OtherMEDICA CHOICE
ID718ANOtherBCBS
1000017OtherMEDICA PRIMARY
20953OtherARAZ AMERICAN PPO
31433OtherLICENSE #
D81232Medicare UPIN