Michelle Louise Anderson
Individual provider Active NPI Physician Assistant · Duluth, MN
NPI 1043247802 · NPPES record last updated Apr 29, 2011
Key facts
- NPI
- 1043247802
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 9589 (MN)
- Practice address
- 400 E 3Rd St
Duluth, MN 55805-1951 - Phone
- (218) 786-8364
- NPI assigned
- Jun 27, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN, WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050330000166 | MN | Practitioner - Physician Assistant | 3971559246 | Reassigns benefits to 2 organizations |
| I20080916000177 | WI | Practitioner - Physician Assistant | 3971559246 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9589 | MN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Mary'S Medical Center | Current |
Accepting new patients | |
| The Duluth Clinic, LTD | Current | Accepting new patients | |
| St Mary'S Hospital of Superior | Current |
Accepting new patients | |
| St. Mary'S Hospital of Superior | Current |
Accepting new patients | |
| St. Mary'S Duluth Clinic Health System | Current | Accepting new patients | |
| The Duluth Clinic LTD | Current |
Accepting new patients | |
| The Duluth Clinic, LTD | Past | Accepting new patients |
Locations
115 10th Ave NE
Deer River, MN 56636
Phone (218) 246-2900
115 10th Ave NE
#A
Deer River, MN 56636
Phone (218) 246-8275
402 E 2nd St
Duluth, MN 55805
Phone (218) 786-3443
400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364
4855 W Arrowhead Rd
Hermantown, MN 55811
Phone (218) 786-3540
901 9th St N
Virginia, MN 55792
Phone (218) 741-3340
11134 N State Road 77
Hayward, WI 54843
Phone (715) 634-5505
707 Ash St
Spooner, WI 54801
Phone (715) 635-2151
3500 Tower Ave
Superior, WI 54880
Phone (715) 392-8281
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 9589 | MN | Yes |
Addresses
Primary practice location
400 E 3Rd St
Duluth, MN 55805-1951
Mailing address
400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 186683400 | Medicaid | MN |
Other providers in Duluth, MN
- Kristina Kay Anderson
- Marie Anderson
- Mark Anderson
- Meredith Anderson
- Michael Kris Anderson
- Molly Ann Anderson
- Neil J Anderson
- Paul Richard Anderson
- Robb Evan Anderson
- Robin Joy Anderson
All providers in Duluth, MN · Physician Assistant in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.