Provider Demographics
NPI:1902126998
Name:ANDERSON, TODD W (DO)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MACINNES DR
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1144
Mailing Address - Country:US
Mailing Address - Phone:906-483-1860
Mailing Address - Fax:906-483-1270
Practice Address - Street 1:600 MACINNES DR
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1144
Practice Address - Country:US
Practice Address - Phone:906-483-1860
Practice Address - Fax:906-483-1270
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine