Provider Demographics
NPI:1699719260
Name:ANDERSON, NORBERT O (MD)
Entity type:Individual
Prefix:
First Name:NORBERT
Middle Name:O
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:26811 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-4075
Mailing Address - Country:US
Mailing Address - Phone:586-755-4433
Mailing Address - Fax:586-755-6655
Practice Address - Street 1:2000 CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9293
Practice Address - Country:US
Practice Address - Phone:989-673-3191
Practice Address - Fax:989-673-0064
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010222122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB44118Medicare UPIN